A preventable tragedy: maternal mortality.

In this year's Call for Action for May 28, International Day of Action for Women's Health, the Latin American and Caribbean Women's Health Network has taken up an historic priority of the women's movement, urging groups and organizations throughout the region to reconfirm their commitment to promoting women's health, particularly the prevention of death and illness related to pregnancy and childbirth. This campaign to promote maternal health will also be a priority area of work for LACWHN throughout the years to come.

The decision to re-launch the campaign to prevent maternal mortality, the focus of seven years of May 28 activities through the collaborative efforts of LACWHN and the Women's Global Network for Reproductive Rights (WGNRR), is due to the overwhelming lack of progress in efforts to eradicate maternal mortality in the developing world. In fact, maternal mortality rates have actually increased in some countries due to a number of social, economic and political factors.

Among all the indicators of human development used today, maternal mortality reveals most dramatically the differences between industrialized and developing nations which Elsa Gomez, the Director of the Gender, Health and Development Unit of the Pan American Health Organization, calls "alarming evidence of inequity, bearing in mind that these deaths are essentially preventable and that for many years now we have had the scientific knowledge and the simple technology to prevent them."

"Maternal mortality rates reveal a direct correlation to the development of health care systems," she adds, "particularly with regard to coverage and quality of the services, priorities in the allocation of resources for the prevention of maternal mortality, and equitable access to good quality care." This means that while a country's level of economic development is important, so are its priorities in terms of the allocating resources for the prevention and treatment of complications in pregnancy.

While maternal mortality rates have decreased in Latin America and the Caribbean in recent years, some countries (or regions within a country) still have alarmingly high rates, as high as in the poorest African nations. Between 20,000 and 30,000 women die every year in our region due to complications related to pregnancy and childbirth. In several Latin American and Caribbean countries, these complications are one of the five leading causes of death among women aged 15 to 49.

In light of this dramatic reality, the Latin American and Caribbean Women's Health Network has decided to focus on maternal health in commemoration of May 28, channeling the participating groups' efforts into three areas:

* Actions to denounce social, political and economic factors that contribute to maternal mortality and morbidity, particularly the failure to recognize and promote women's right to make decisions regarding their own sexual and reproductive lives and the lack of timely access to high-quality health services, including emergency obstetric services;

* Education and consciousness-raising activities targeting society in general and women in particular that empower them to demand immediate treatment in emergency situations and that teach essential issues of maternal health, special care during pregnancy and the signs of a high-risk pregnancy; and

* Promotion of the highest-quality comprehensive health care available and quality of care from health care professionals working in women's sexual and reproductive health.

As a contribution to this day of action, we include LACWHN's 2003 Call for Action and information from the Safe Motherhood Initiative, which was created in 1987 in response to various UN agencies' concerns regarding maternal deaths.

MAY 28, INTERNATIONAL DAY OF ACTION FOR WOMEN'S HEALTH

Maternal Mortality: An Issue of Human Rights, A Matter of Social Justice

Fifteen years ago in 1988, LACWHN launched the first Call for Action in commemoration of May 28, International Day of Action for Women's Health. In coordination with the Women's Global Network for Reproductive Rights (WGNRR), LACWHN coordinated the campaign for the Prevention of Maternal Mortality and Morbidity, an event that made history in the international women's movement, uniting the efforts of hundreds of groups and organizations from around the world.

In 2003, LACWHN's May 28 Call for Action once again takes up the continuing concern of maternal mortality in our region under the motto "Maternal Mortality: An Issue of Human Rights, A Matter of Social Justice."

The Statistics Speak for Themselves

* Every minute, 380 women become pregnant, and 190 of these pregnancies are unplanned and/or unwanted.

* Every day, complications related to pregnancy or childbirth result in 1,600 deaths--some 600,000 women annually--and 99% of these deaths occur in developing countries.

* In most of the countries in our region, complications related to pregnancy and childbirth are the leading cause of death and disability for women aged 15 to 49.

* In Latin America and the Caribbean alone, more than 25,000 women die every year due to complications in pregnancy or childbirth.

* For every case of maternal mortality there are an estimated 30 to 100 cases of illnesses or disabilities related to pregnancy and childbirth.

* Bleeding, infections, eclampsia, obstructed birth and complications related to abortion are the primary causes of maternal mortality. In several countries in our region, unsafe abortion is a leading cause of maternal death (PAHO/WHO 2002).

According to the World Health Organization, the gap between developed and developing countries is widest in the matter of maternal mortality. These notorious differences are the clearest evidence of the inequities in health that women continue to face, despite abundant information on the leading causes of maternal deaths and the best ways to prevent maternal mortality and morbidity.

By region, the likelihood that a woman will die due to complications in pregnancy or childbirth or as the result of abortion-related complications is:

* Africa: 1 in 15;

* Asia: 1 in 105;

* Latin America and the Caribbean: 1 in 150;

* Europe: 1 in 1,895;

* North America: 1 in 3,750.

Higher rates of maternal mortality are largely explained by cultural factors such as the lower social value assigned women and their lack of power with which to make decisions regarding their own sexuality and reproduction. Other factors include women's unequal access to employment, education and resources; situations of poverty; repeated pregnancies and malnutrition which leave women physically weak; poor conditions of health and hygiene in their surrounding environment ... in other words, situations of extreme social disadvantage.

Nonetheless, the United Nations Population Fund (UNFPA) calculates that providing standard maternal and infant care would significantly reduce maternal mortality in poor countries and only cost three dollars per person annually. The UNFPA also maintains that the reduction of maternal mortality is related more closely to effective and accessible treatment and quality of care than with the general socio-economic situation of developing countries.

The sad injustice of this situation is that maternal mortality can be prevented with inexpensive, easy-to-implement interventions. But also required are political will and commitment to promote equity, social justice, and women's sexual and reproductive rights, especially of the poorest, those living in rural areas, and young, indigenous and African-descendant women, who frequently suffer discrimination related to access to resources and services and who are the most likely victims of maternal mortality.

Our governments and various international organizations signed numerous commitments that take a clear stand on maternal mortality:

According to the Programme of Action from the International Conference on Population and Development signed in Cairo in 1994, reproductive health "implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. Implicit in this last condition [is] the right of access to appropriate health-care services that will enable women to go safely through pregnancy and childbirth."

The Platform for Action from the Fourth World Conference on Women (Beijing 1995) takes up the spirit of Cairo, stating: "Complications related to pregnancy and childbirth are among the leading causes of mortality and morbidity of women of reproductive age in many parts of the developing world ... Most of these deaths, health problems and injuries are preventable through improved access to adequate healthcare services, including safe and effective family planning methods and emergency obstetric care."

At the same time, Ministries of Health throughout the region have adopted Resolutions and Plans of Action drafted by the Pan American Health Organization that aim to reduce maternal mortality through a number of recommendations, including:

* The incorporation of a gender perspective in health promotion efforts in order to improve the effectiveness of policies and programs;

* Monitoring the impact of health policies and reform processes on gender equity in health; and

* The comprehensive development and application of models that address gender inequities in health.

However, these plans of action and resolutions will remain nothing more than words on paper unless we take action to demand their implementation.

The Path Towards Prevention

As part of its strategy to reduce maternal mortality and morbidity in the region, PAHO recommends:

* Encouraging respect for women's human rights;

* Promoting improved socio-economic conditions for women;

* Delaying marriage and birth of first child;

* Recognizing that all pregnancies imply risks;

* Ensuring quality of care in childbirth;

* Improving health-care coverage;

* Improving quality of care in health;

* Promoting the empowerment of women to make decisions regarding their own health and rights.

PAHO also emphasizes the importance of a focus on cost-effective interventions at the level of primary care, educating women, their families and communities on maternal health care and how to recognize the warning signs of high-risk pregnancies. In addition, PAHO promotes Emergency Obstetric Centers that would provide immediate care for high-risk pregnancies 24 hours a day.

However, public hospitals and clinics--where women are the principal users- have been seriously damaged by the application of liberal health sector reforms and the focal policies of the World Bank in Latin America and the Caribbean. As a result, public polices must be encouraged to promote PAHO's strategies, monitor the healthcare system and demand comprehensive reproductive health care.

In this effort, the Latin American and Caribbean Women's Health Network issues this call to demand the protection of the human right to enjoy a safe and healthy pregnancy, an issue of historic importance to the women's health movement and a struggle that the Network hopes to share with other social movements. LACWHN maintains that:

* Women's empowerment as citizens able to defend their rights, starting with the right to make decisions over their own bodies, sexuality and reproduction, is key to reducing maternal mortality, which in most cases is preventable.

LACWHN calls on all women's organizations of the region to send proposals for actions to promote the prevention of maternal mortality and morbidity, developing activities around the following lines:

* Educational campaigns to prevent risks in pregnancy and childbirth;

* Political pressure for the implementation of comprehensive reproductive health care, with emphasis on access, quality and equity;

* Concrete actions according to the realities of each country; and

* Education aimed at young people through forums, workshops, etc., about their right to enjoy comprehensive sexual and reproductive health.