A mother’s worth


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“Despite encouraging results and international efforts, maternal mortality rates worldwide are still at much higher levels than hoped. All across the globe, mothers still die from preventable causes and their access to maternal healthcare is still based on ethnic discrimination.”

As I write this, thousands of mothers are fighting for their lives worldwide, especially in developing countries. But even in the so-called developed countries, are we doing enough for all our women? How much is the life of a mother worth? And does that worth change as her skin colour and geographical areas change?

The reality is cruel and inhuman. In 2015 alone, 303 000 women died during and following pregnancy and childbirth. A heart-breaking number of 830 women die every day, 99% of them in developing regions of the globe 1. Even in more developed countries, women are still dying from child birth and maternal mortality is higher for women in ethnic minorities 2.

In 2010, Safe Motherhood was considered a Human Rights issue by the United Nations Human Rights Council, in an effort to increase accountability for preventable maternal mortality 3. In 2015 the Global Strategy for Women’s, Children’s and Adolescents’ Health 2016-2030 was created, also highlighting the importance of accountability 4. Simultaneously, Sustainable Development Goal number 3 was issued with one ambition, among others, to decrease the global maternal mortality ratio to under 70 per 100 000 births. There was a worldwide decline in this ratio of 2.3% between 1990 and 2015, with an overall drop of 44% in maternal mortality 5. Some countries, especially in Asia and Northern Africa, are doing impressive work and achieving inspiring results.

Despite all these positive changes, maternal mortality rates in developing countries are still unacceptably high (at an estimated of 239 per 100 000 live births) 5, and they are especially high in sub-Saharan regions and South Asia. The probability of a 15-year-old girl dying from child birth (Woman’s Lifetime Risk of Maternal Death) reaches 1 out of 54 women in the poorest areas 5.

But what about the developed countries? For instance, in the US there has been a sharp decrease in pregnancy-related mortality since the beginning of the 20th century. However, 600 women still die each year because of pregnancy or childbirth 6. Moreover, it is astonishing that as the pregnancy-related mortality in the US has decreased, the gap in these numbers between white and black women has increased.

According to several studies, African-American women have a 3-4 times higher risk of dying during motherhood compared to their white counterparts 2,7. To a lesser degree, other minorities in the US also have a bigger risk than white women. Even when analysing disease and risk factors associated with racial differences, insurance coverage, maternal age or low socio-economical background, this difference remains 7. In fact, this gap was bigger when mothers had lower absolute risk2. In the 1980 National Natality Survey, it was reported that prenatal advice and diagnostic tests offered varied considerably according to social and demographic backgrounds of the pregnant women8.

In Brazil, Alyne da Silva Pimentel, a Brazilian woman of African descent, died from pregnancy-related causes after misdiagnosis and delays in obstetric care. In August 2011, the Committee on the Elimination of Discrimination Against Women, established that all women, despite their racial and economic backgrounds, must have timely and non-discriminatory access to maternal health services and that the States must be held responsible for this. It issued a statement regarding Alyne da Silva Pimentel v. Brazil 9, making it the first decision issued by a UN Rights body on maternal mortality. Sadly, she was one of the countless cases of women worldwide who was not provided with appropriate care because of their skin colour.

In 2017, girls everywhere are still considered less worthy than their brothers, husbands, sons and fathers. Their contributing value to society is wrongly depicted as less, making them ‘less’ citizens, ‘less’ human, ‘less’ worthy to save. Girls, especially of coloured-skin, from the poorest areas of the globe are considered less worthy than in developed countries. Pregnancy shouldn’t be seen as a disease or a death sentence. Maternity is a gift; shouldn’t we treat our mothers as such?

 

 

1 Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A, et al. Lancet. 2016; 387 (10017): 462-742

2 Saftlas AF, Koonin LM, Atrash HK. Racial disparity in pregnancy-related mortality associated with livebirth: can established risk factors explain it? Am J Epidemiol 2000; 152:413–19.

Report of the Office of the United Nations High Commissioner for Human Rights on preventable maternal mortality and morbidity and human rights. Geneva: United Nations High Commissioner for Human Rights; 2010.

4 Commission on Information and Accountability for Women’s and Children’s Health. Keeping promises, measuring results. Geneva: World Health Organization; 2011

5 Maternal Mortality, Fact Sheet, Geneva: www.who.int; November 2016

6 Pregnancy Mortality Surveillance System, www.cdc.gov

7 Creanga AA, Bateman BT, Kulina EV, Callaghan WM. Racial and ethnic disparities in severe maternal morbidity: a multistate analysis, 2008-2010. Am J Obstet Gynecol 2014; 210:435. e1-8.

8 P J Placek, the 1980 National Natality Survey and National Fetal Mortality Survey–methods used and PHS agency participation. Public Health Rep. 1984 Mar-Apr; 99(2): 111–116.

9 Communication No. 17/2008. Committee on the Elimination of Discrimination against Women, forty-ninth session, 11 to 29 July 2011. New York: CEDAW; 2011.

 

Image retrieved by bbc.com

 

 

margarida phot Margarida Paixão is a medical doctor, currently working as a Public Health resident in Portugal. She attended NOVA Medical School in Lisboa and besides her medicaI work, she has an interest in Human Rights.

 

 

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