Is cutting the death rate among women in pregnancy and childbirth in poor countries an impossible task? Sometimes it may have seemed so. Too difficult, too expensive, too many women scattered through too many countries with far too few midwives and obstetricians between them. We seemed to be stuck on half a million tragic deaths a year forever. But, according to the Institute for Health Metrics and Evaluation at Washington University in the USA, the death rate has been going down after all. Quite dramatically.
In the past 30 years, say Christopher Murray and colleagues who have just published online with the Lancet medical journal, that figure of 500,000 a year has come down to 343,000. That is a drop of 35%. It's remarkable news - and all the more remarkable because it's been happening without anyone realising it. It's like waking up and finding somebody has demolished the ugly old building across the road and planted trees instead. Hard to believe the scenery has changed quite so dramatically. The new optimistic outlook will take some getting used to. This is what Dr Murray told me.
The whole community has been living off 500,000 women dying a year for the last 30 years. That's fed a sense of almost pessimism that it is difficult to change maternal mortality.
Murray and colleagues have got new data, that has not been systematically put together in the past, and new tools. They are confident the numbers are right, but given that the community was been wedded to the 500,000 a year death rate for so long, they fully expect discussion.
This is glass-full versus glass-empty territory. Does this mean the problem is not as great as people thought, or that the global effort to save women's lives of recent years has been having an impact? Crucially - does it mean we need more money for maternal health or less?
Hopefully, this will give donors heart as well as campaigners. It must surely mean that we are getting somewhere and that what appeared to be the hardest of the MDGs to reach is attainable after all.
There are other important messages from this research. Death rates have gone down in developing countries generally, but in eastern and southern Africa they have gone up. And the reason is HIV, says Murray:
Most people hadn't realised there is a very strong link between HIV and maternal mortality. There are 60,000+ maternal deaths related to advanced HIV.
What's the message from that? We pretend that HIV/AIDS is no longer an urgent priority for donor funds at our peril. It is exceptional. But at the same time, it says much about the interlinking of health conditions and the need to tackle every aspect of ill-health and poor healthcare in the developing world in a joined-up fashion.
Murray and colleagues may have started a debate about maternal mortality here, but they set off something even more complex and controversial, with a paper - in conjunction with others - which found that developing world governments cut their own funding for health when they received large sums earmarked for that purpose from donors. Some say that's as it should be - governments must decide their own priorities. Others worry about the chances of health funding ending up paying for tanks. The message the Lancet, which also published this paper, tried to get across was that developing world governments have increased their own spending on health massively in recent years. It will be interesting to see how much play that argument gets.
Source: Sarah Boseley, Guardian Unlimited,12 April 2010 or http://www.ippf.org/
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