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Birth, a measure of progress

Reducing maternal and newborn mortality has to be a priority if Africa is to reach its potential.


Whatever continent or country you live in, childbirth should be a joyous occasion. But for millions of people around the world it is a time of grief and despair. More than 280 000 mothers lose their lives because of complications in pregnancy and childbirth every year, and more than three million newborns die.

Most of these deaths are avoidable as they are not the result of illness or disease; they are the consequence of the process of giving birth. A lack of access to family planning, basic care around childbirth, skilled attendants, health checks and advice during pregnancy are the main reasons for these avoidable deaths. These reasons also explain why the vast majority of maternal deaths occur in developing countries.

Efforts have been made by the international community and the United Nations to reduce maternal mortality. The millennium development goals, agreed on by world leaders in 2000, set an ambitious target of reducing maternal deaths by three-quarters and achieving universal access to reproductive health by 2015. The results show what can be achieved, with maternal mortality almost halved in the past two decades.

But these reductions are still not happening fast enough to meet the target for maternal health, nor are they visible across all countries or regions in the developing world. This is particularly the case in sub-Saharan Africa, which has the highest mortality rate in the world.

A recent study in the highly authoritative medical journal Lancet showed that, in 2008, eight of the 10 countries with the worst maternal mortality record were in Africa. A woman on the continent is almost 100 times more likely to die because of pregnancy and childbirth-related complications than in wealthy countries.

Badly hit

But the continent has also seen some astonishing success stories on maternal health. Equatorial Guinea, for example, has already surpassed the 75% reduction target. Eritrea, too, is on course to meet the goal. Ethiopia and Rwanda are among other countries with reductions of more than 60% already.

Despite this progress, a continent with only 14% of the world’s population still accounts for more than half of all maternal deaths. Countries that have been particularly badly hit by the HIV/Aids epidemic have seen figures rise, rather than fall, in recent years.

Saving mother’s lives in Africa needs the sustained involvement of the entire international community. But African countries, their governments and civil society have the potential to have the biggest effect. This is what is happening through the Campaign for Accelerated Reduction of Maternal Mortality in Africa — launched in 2009 by the African Union with the support of the United Nations Population Fund, which I am privileged to head.

Already, 37 countries have signed up to the campaign. The aim is to galvanise additional political action, adequate funding support and new partnerships to take the steps needed to put an end to all avoidable maternal deaths.

We have had tremendous buy-in right from the top. In Zambia, for example, the initiative was launched by the president. The same happened in several other countries across the continent, where committed leaders faced their nations’ health challenges. We have already seen some remarkable results.

Increased funding

To tackle the shortfall of skilled practitioners, Cameroon, for example, is opening eight new midwifery schools. In a country where the last midwife had graduated in 1987, more than 200 students are completing their training.

We see similar success stories right across Africa with strengthened health systems, increased funding and new partnerships. But all the countries that have already shown support for the campaign — and those that have yet to be engaged — know there is more to do.

This is why the campaign’s high-level event taking place in Ethiopia this week under the auspices of the African Union and the United Nations Population Fund is so important. It is a chance for countries to recommit themselves to the campaign’s aims and to share good practices.

It is not acceptable that pregnancy and childbirth continue to be a death threat to so many African girls and women.

If the continent is to carry on the remarkable economic and social progress made over the past decade and make the most of its rich potential, then reducing child and maternal deaths has to be a priority.

The decisions taken in Addis this week will help to drive forward Africa’s positive transformation. It is not just in the interest of Africa but also the whole world that we build on the progress that has been made. It is within our reach that no woman should die while giving life. The realisation of this commitment is also in our hands.

Dr Babatunde Osotimehin is the executive director of the United Nations Population Fund.