The things they carry

The latest figures on global maternal mortality, which I've written about in the last two posts here on Birth Story, are encouraging. But are they correct?

The new figures, in a study funded by the Bill and Melinda Gates Foundation, are much more positive than the ones the World Health Organization came up with in 2006. Advocate groups fear that the brighter statistics will slow down progress on making birth safe for women in developing countries.

The New York Times columnist Nicholas Kristof, who has made a specialty of chronicling the dire state of women in the world's least prosperous areas, wrote in his blog "On the Ground" on April 16 that "when women die in childbirth in poor countries, nobody keeps track, and so all these figures are very rough estimates."

Imagine that. A mother dies, and nobody even writes it down.

I am a regular reader of Kristof's column, as he consistently mines the rich vein of human interest stories about indigent women.

Kristof has done some great video work on "On the Ground."  Video gives a face -- and a voice -- to the actual women who are living the difficult lives he writes about.

I would recommend taking a look at Kristof's videos from eastern Congo, although some of them are terribly upsetting, as many of these women have been brutalized in the political unrest there.

Here is one video that is simply illuminating, "What Are You Carrying?"

Four good trends for the world’s women

"Women have long delivered for society, and, slowly, society is at last delivering for women. This is a moment to celebrate—and accelerate," The Lancet editor-in-chief Richard Horton wrote in a commentary that accompanied the publication of a new survey on global maternal mortality the British journal published on Monday.

Four factors associated with maternal mortality are moving in a good direction in many areas of the world, according to the study published this week, which was discussed in the previous post here on Birth Story.

First, the global total fertility rate (TFR), which reflects births per woman, has come down considerably, from 3.7 children in 1980, to 2.6 in 2008. That is a good thing, as the TFR is closely associated with maternal mortality.

Secondly, per capita income is also up, especially in Asia and Latin America. When families have more money, women get more nourishing food, and are more likely to get access to medical care.

Women are also more likely to get some education than they were 30 years ago, which bodes well for a society in which mothers can give birth in a safe environment. Women 25 to 44 years of age in sub-Saharan Africa had 1.5 years of school in 1980, but now have 4.4 years of school on average.

And lastly, women are more likely to have skilled birth attendants in 2008 than they were thirty years ago. "Some large countries such as India have witnessed quite rapid increases in skilled birth attendance in recent years," the study reports.

Surprises in a new study of maternal deaths

Scratch that last post.

It appears that societies around the world are working to improve the survival rate for mothers in birth after all -- and that their efforts are working.

Even as I was tapping out Monday's post, The Lancet was publishing a new study online that shows that maternal mortality has actually been dropping dramatically in many countries.

"The overall message, for the first time in a generation, is one of persistent and welcome progress," Lancet editor-in-chief Richard Horton wrote in a commentary that accompanied the study.Pregnant Graffiti

The number of maternal deaths per year worldwide has been tallied at 500,000+ in 2005, based on United Nations survey published in 2007. However, the new study, which was conducted by researchers at the University of Washington and the University of Queensland in Brisbane, Australia, and funded by the Bill and Melinda Gates Foundation, shows deaths to have fallen from 526,300 in 1980 to 342 ,900 in 2008. That's good news.

Not only that, but taking out deaths from HIV/AIDS, which has emerged as a major factor in global maternal mortality, the figure would have been 281,500 in 2008.

More than half of maternal deaths are concentrated in six countries-- India, Nigeria, Pakistan, Ethiopia, the Democratic Republic of Congo, and Afghanistan, which has the highest maternal mortality rate in the world, this survey states. (Italy has the lowest rate, according to this report.)

The United States, Canada, Denmark and Norway are among the prosperous nations that are experiencing increases in maternal mortality (less than 1 percent for the U.S.). More comprehensive reporting could account for the increase, the researchers noted.

Not everyone is excited by the new survey's findings, Horton wrote in his commentary.

"Even before the paper ... was submitted to us, we were invited to “delay” or “hold” publication," by some members of  what Horton calls the "global health community" who fret that the relatively rosy picture the new study paints will lead to a flagging interest in working to make birth safer around the world.

Horton dismisses those worries, but expresses concern that the figures in the new report are so different from those in the 2007 UN survey.

"A process needs to be put in place urgently to discuss these figures, their implications, and the actions, global and in country, that should follow," he writes.

So it appears that MDG5, the Millennium Development Goal that has to do with improving birth safety for moms is, after all, alive and well.

"This new evidence suggests there is a much greater reason for optimism than has been generally perceived, and that substantial decreases in the (maternal mortality rate) are possible over a fairly short time," the report states.

Image by Petteri Sulonen

Women’s lives not a priority?

The world is seeing progress on such worthy goals as ending hunger and extreme poverty, conquering pervasive health menaces like AIDS and malaria, achieving universal primary education and ensuring environmental sustainability.

However, of the eight Millennium Development Goals the United Nations and partner organizations set in 2000 for achievement by 2015, lowering the number of the world's women who die in childbirth is the farthest from being met, according to UN Population Fund Executive Director Thoraya Ahmed Obaid, speaking at a meeting last fall  in Addis Ababa, Ethiopia.

"Women’s lives, dreams and rights have not been given the priority attention they deserve,” Obaid said.

"We know what works and needs to be done," Obaid said -- education, medical supplies and services that include prenatal care, the availability of skilled birth attendants and emergency obstetrical care.

But while funding for other health goals has risen significantly during this period, money tagged to improve reproductive health has remained static, Obaid said. And so the birth story continues to be a tragic one in 500,000 families throughout the world every year.

“It would cost the world $23 billion per year to stop women from having unintended pregnancies and dying in childbirth, and to save millions of newborns. This amounts to less than 10 days of global military spending. Instead, the world loses $15 billion in productivity each year by allowing mothers and newborns to die,” she said.

See more recent post, which contradicts this one!

The Wrong Guy

One of the points Dr. Robert Wachter made in his speech at the ACOG meeting in May, 2009, was that everybody makes mistakes. True, people can wind up dead when doctors make mistakes, but everybody else makes mistakes, too.

To illustrate his point, Dr. Wachter showed a video from the BBC, "The Wrong Guy," the tale of two men named Guy who were waiting in reception areas in the BBC's London offices on the same day in 2006.

One was there to interview for a job.  The other, an expert on information technology, had been scheduled to hold forth on the network's News 24 program about a ruling in Apple Corp.'s suit against Apple Inc. The Beatles' music company and the computer firm had previously agreed to stick to their own businesses. But then came iTunes, and Apple Corp. sued Apple Inc. for alleged encroachment on its music brand.

A London judge ruled in Apple Inc.'s favor and the BBC invited tech expert Guy Kewney on to chat about the ruling. But it was Guy Goma, the unwitting job applicant, who was summoned from the waiting room for the interview.

The look on "the wrong Guy's" face when he catches on to who they think he is is priceless!