Fertility and Fatality: Breaking the Link

| April 16, 2012 | 0 Comments

A Chadian proverb states, “A pregnant woman has one foot in the grave.” [1] Sadly, this harrowing statement is not far from the truth.  By day’s end, more than 1,000 women will have died from a pregnancy or childbirth related complication. [1] In the developing world, where 99% of maternal deaths occur, fertility and fatality are intimately acquainted. For an Asian or African woman, giving life is the most deadly act she can perform. More disturbing still is that these deaths are nearly always preventable. Bleeding, bacterial infections, obstructed labor and unsafe abortions are the major killers of poor women. [1]

Health care is a fundamental human right. Yet until gender, class and ethnicity cease to be the most potent determinants of an individual’s health status, there is no denying that global health inequality is an egregious form of human rights violation.  The current rate of maternal mortality is evidence of such. Although the 2000 Millennium Development Goals committed the world to a 75% reduction in maternal mortality by 2015, global reductions have been generally stagnant and sluggish at best. Yearly reductions are consistently at less than half of their projected targets. [2] In a decade that has seen global health funding skyrocket, women continue to die in staggering numbers from preventable causes. In an era where more people claim a commitment to global health than ever before, the maternal mortality rate is unconscionable. Where then must we look for a solution?

The indisputable correlation between maternal mortality and poverty provides an answer.  If maternal mortality disproportionately affects impoverished women in societies where women traditionally enjoy fewer liberties than their male counterparts, the health of these women must be addressed within the framework of these economic and political realities. It is imperative now more than ever that the discourse of maternal health be pushed beyond a purely medical conversation. Health is as much an outcome of biology and physiology as it is the social, political and economic climates that surround the woman. [3] Ninety-nine out of one hundred women who die in childbirth live in countries where the average income is $1 a day, where female sexual education is limited or nonexistent and where female fertility is paramount to social inclusion. [3] By contextualizing maternal mortality as a biosocial problem, the issue becomes much greater than inadequate access to midwives and prenatal care. A woman’s right to sexual freedom, sexual education, birth control, the ability to choose when (and if) she wants to have children are also paramount to combatting maternal health. Thus far we have a faced a chronic failure in addressing these root problems. Progress will only come when we make visible the underlying forces at work.

Tonk District in Rajasthan, India. Women train to become community health workers, nurses and midwives. Photo courtesy of UN Chronicle.

Yet there remains cause for great hope. Many communities have achieved marked success as a result of their attention to structural causes. In Bangladesh the government began providing free female education. This reduced unwanted pregnancies, provided women with vital skills to advocate for control of their bodies and ultimately shaved 53% off the maternal mortality rate. [4] In Rwanda, family-planning agencies expanded prolifically. Behavior change messages about female sexual rights and contraception were targeted at both men and women and maternal mortality plummeted 25% in half a decade. [4] In a village in Mali men were actively educated about the dangers of childbirth and women formed collective rice and peanut farms to fund personal healthcare. Husbands grew more willing to contribute to their wives pre and postnatal medical care and women’s heightened financial independence provided them with greater freedom when making medical decisions. The village has not had a single maternal death since 2002. [5] As these communities have shown this challenge is far from insurmountable. Education, economic independence and cultural awareness are key. It is about paying attention to the individual experience, discerning how seemingly small events can impact major change. It is about attending to the little details, just like our mothers have taught us to do.


[1] “Maternal Mortality.” World Health Organization. Nov. 2010. Web. 9 Feb. 2012.

[2] “Progress towards the Millennium Development Goals,1990-2005.” UN Statistics Division. 2005. Web. 17 Feb. 2012.

[3] Farmer, P. (1996). Women, Poverty and AIDS. In P. Farmer, M. Connors, & J. Simmons (Eds.), Women, Poverty and  AIDS(Vol. 1, pp. 1-40). Monroe, ME: Common Courage Press.

[4] “Reducing maternal mortality: countries to inspire continued commitment.” Women Deliver. 2011. Web. 17 Feb. 2012.

[5] Cisse, Almahady. “Women Clock Up Success With Maternal Mortality MDG.” Inter Press Service News Agency. 13 Aug.  2004. Web. 9 Feb. 2012.

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