Pre-G20 in Toronto: the real deal on maternal health

What does it take to really help mothers stay healthy? An Amnesty International presentation on maternal mortality in Peru in the context of Millennial Development Goals, part of the People’s Summit held in Toronto June 18-20 to counterbalance the upcoming G20 forum for the world’s richest economies, provided some answers.

In Peru, the to-do list is likely longer than Canadian International Co-operation Minister Bev Oda’s. There’s a need for social change to empower women’s decision-making, roads for people to get to health centres, bilingual people fluent in Quechua and English and… perhaps to start, a budget for the Maternal Mortality National Plan. That’s right: with one of the highest maternal death rates in the Americas at 185 per 100,000, Peru has allocated no money at all to improve the situation. Meanwhile, U.N. estimates of maternal mortality are closer to 240 deaths per 100,000. Why the discrepancy? Ruth Mier y Terán Moscoso, responsible for campaigns and training in the Peruvian section of Amnesty International, points out the government has a vested interest in keeping maternal mortality rate reports as low as possible. Bigger issues, of course, need bigger solutions, which cost more money.

Presumably, this is the kind of problem the Harper government in Canada intended to solve, and should solve, with its maternal health initiative for developing countries, $1 billion over five years, which initially excluded any sort of birth control funding and still excludes abortion services. There’s just one thing: women need to control more of their lives, and their governments, for any real progress to happen.

Each year, some 500,000 women worldwide die during pregnancy or while giving birth and nine million children die before they reach the age of 5, according to Canadian International Development Agency (CIDA) statistics. About 2.5 million teenagers have unsafe abortions each year and tend to be more seriously affected by complications. That’s just the start of issues recorded during the World Conference on Women in Beijing in 1995, as noted by Amnesty International Women’s Human Rights Campaigner Lindsay Mossman. At the heart of maternal health is the need for the mother to have the capacity to make independent decisions about her reproductive choices, from age of marriage to contraception use. Once this is secured, mothers need access to care.

Marrying young puts mothers at risk. Women from 15 to 19 are twice as likely to suffer complications from pregnancy. Women under 15? Five times as likely. Choice is crucial. In Peru’s rural communities, the hardest-hit by poverty and lack of health care, choice is something women don’t have, explains Mier y Terán Moscoso. The power of women is an issue, as only men (with the exception of widows) have the right to vote in local assemblies. Women have no choice about having children, she says. It depends on the husband.

At the systemic level, abortion is currently illegal in Peru except to protect the health of the pregnant woman. Whoever seeks an abortion without being at risk faces two years in prison and the doctors performing it, four years. Ambiguity over what constitutes a health risk makes doctors hesitant to perform any abortions at all, says Mier y Terán Moscoso.

Meanwhile, rural areas are the hardest hit by a lack of access to health care, with subsequently higher maternal death rates. Eight out of ten communities in Peru rated as extremely poor are in rural areas. Many have indigenous populations and 40 per cent of indigenous people have no identity papers, which must be obtained in Spanish. Therefore, they have no access to universal health care. Physical access is also a problem: 51 per cent of all communities have no health centre at all. Half of those who do have only a first-aid post. And while the government has paved roads for exploration of mining and oil rights, many rural communities with human beings as their only resource have no roads at all.

Meanwhile, when doctors do appear, they may face extremely difficult conditions, working very long hours. They do not speak indigenous languages, so that in the absence of interpreter services, they won’t be able to communicate with patients. Women in rural indigenous communities are less likely to speak Spanish than men. For this reason, they may also face difficulties in taking medicine as prescribed. As a result of all these factors, only 36 per cent of women in rural areas go to a health care centre or see a health care professional.

Therefore, the picture of health goes beyond the wish or intention to provide services. Empowering women helps take away much of the risk of pregnancy and birth. Helping communities gain access to health care can involve more than training or hiring doctors, and may involve substantial investments in infrastructure, as well as cultural training to better harmonize accredited practice with traditional care and customs. And, of course, once the children are born, they matter, at the very least, every bit as much as when they were in the womb. Healthy mothers are the main part of the development solution.

Toward these ends, Amnesty International has produced a report entitled Fatal Flaws – barriers to maternal health in Peru. The Canadian Chapter also has a wealth of information about the issue worldwide on its “End Maternal Mortality” blog.