Who's Not Happy About a Falling Maternal Death Rate?

One of the most astounding improvements in human history has been the ever-shrinking rate of maternal death. As we wrote in SuperFreakonomics*, while telling the story of Ignatz Semmelweis:

In industrialized nations, the current rate of maternal death during childbirth is 9 women per 100,000 births. Just one hundred years ago, the rate was more than fifty times higher. In colonial America, women described childbirth as “the greatest of earthly miserys” and “that evel hour I loock forward to with dread.” Indeed, there were a lot of things to go wrong: hemorrhaging, eclampsia, or an obstructed labor – when the baby, instead of presenting itself head-first, was pointed feet- or derriere-first, getting stuck in the uterus and endangering both mother and child.


The current issue of The Lancet contains a study with some truly great news: despite fears that the rate of maternal death had leveled off, it has in fact been falling significantly, even in the world’s poorest places. The study, funded by the Gates Foundation, argues that the global rate of maternal mortality has fallen thusly:

A couple of important caveats: “More than 50% of all maternal deaths were in only six countries in 2008 (India, Nigeria, Pakistan, Afghanistan, Ethiopia, and the Democratic Republic of the Congo).” And: “In the absence of HIV, there would have been 281,500 maternal deaths worldwide in 2008″ (versus the actual estimate of 342,900). Here’s the Times‘s report on the Lancet study:

The study cited a number of reasons for the improvement: lower pregnancy rates in some countries; higher income, which improves nutrition and access to health care; more education for women; and the increasing availability of “skilled attendants” – people with some medical training – to help women give birth. Improvements in large countries like India and China helped to drive down the overall death rates.

Interestingly, the Times notes that there’s one group of people for whom this great news isn’t necessarily so great:

[S]ome advocates for women’s health tried to pressure The Lancet into delaying publication of the new findings, fearing that good news would detract from the urgency of their cause, Dr. Horton said in a telephone interview.

“I think this is one of those instances when science and advocacy can conflict,” he said.

Dr. Horton said the advocates, whom he declined to name, wanted the new information held and released only after certain meetings about maternal and child health had already taken place.

He said the meetings included one at the United Nations this week, and another to be held in Washington in June, where advocates hope to win support for more foreign aid for maternal health from Secretary of State Hillary Rodham Clinton.

The advocates’ argument, of course, is that more aid is needed to preserve and even improve upon these gains. But it’s always hard to drum up more funds when a problem is seen as on the mend. Maybe the advocates can get some advice from police departments around the country who fight to keep the money flowing even as crime falls.

* It was a shorter version of this segment — without the colonial America bit — that appeared in the finished book.

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  1. PaulD says:

    @brazzy: By the same token I guess someone who favored the legalization of lynching could say that they were not trying to “promote” lynching. They might even say that they are happy not to HAVE to lynch anyone, but needed to have lynching legal should certain undesirable types overstep their bounds.

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  2. Anne says:

    PaulD–That’s not the same thing at all. I favor legalization of marijuana, continued legalization of alcohol, and gay marriage. I have never smoked anything (besides ham), never had alcohol except a champagne toast at a wedding, and wine at church (less than five times, and it was only a sip), and I’m a straight woman, so I won’t be getting a gay marriage. But I fully support the right of others to do these things.

    Your argument is like me calling pro-lifers “pro-postpartum depression,” “pro-child abuse and abandonment,” or “pro-making women have their rapists’ babies”. Your point doesn’t make any sense. Most pro-choice people I know (and I know quite a few) want abortions to be safe, legal, and RARE. No one is suggestion everyone have an abortion all the time, just that they have that option.

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  3. Marc says:

    PaulD is obviously trolling because no serious person would make such a silly argument.

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  4. Matthew R. says:

    While the headline may be misleading and inflammatory, there is certainly a perverse incentive for those whose livelihood revolves around the existence of other people’s misery.

    This reminds me of Chris Rock’s rank about why we haven’t cured a disease in fifty years — because there’s no money in the cure, only in the treatment. Even legal drug dealers know that you only make your money on the come-back.

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  5. brazzy says:

    @PaulD: Indeed most people who considered lynchings justified probably saw it like that.

    The difference is that while there were also quite a few people who lynched out of pure hatred or sadism, nobody aborts a fetus because they hate fetuses or enjoy killing them – least of all the mothers themselves, who have to undergo an uncomfortable, possible painful and risky medical procedure.

    No matter which side of the debate you’re on, trying to demonize the other side by misrepresenting their motivations is not good.

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  6. PaulD says:

    @brazzy: You’re right, no one aborts a child because they hate children. Drunk drivers don’t run over pedestrians because they hate them. Step-fathers don’t molest their step-daughters because they hate them. Ultimately, hate has very little to do with many atrocities. Do many women abort their children out of pure selfishness? I believe so.

    I don’t mean to demonize women who get abortions or those who support an unrestricted right to abortion. But I think the mindset that enables women to justify abortion often rests on what even for them is a very tenuous and uneasy fiction: that that thing growing within them is somehow not a human being. My lynching analogy will of course seem very far-fetched and extreme to someone like yourself who only refers to children in the womb as fetuses. There have been a few liberals who have had the integrity to say: “Yes, that is a human being, but sometimes you have to do what’s best for yourself and there is collateral damage.” If you can take a newborn baby and leave it in a dumpster (as some college students have done of late) and feel no remorse about it, then I will say you at least have a consistent moral schema.

    My heart goes out to a woman who finds herself pregnant and feels that having that baby is going to push her over the edge. To make the best of a bad situation I would want her to give birth to the baby and then give it up for adoption. But perhaps she can’t even afford the medical expenses involved in that. I don’t know — are there arrangements by which an adoptive couple will agree to pay such expenses from the start of the pregnancy? There are no easy answers.

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  7. David says:

    Speaking as somebody who wants abortion to be safe, legal, and exceedingly rare, yes, there have been arrangements whereby an adoptive couple has agreed to pay medical expenses. I don’t know what happens if something goes wrong and there’s suddenly tens of thousands of dollars, and that can happen suddenly.

    I assume, PaulD, that you have never been pregnant. It involves some unpleasant changes to the body, and some of them can be permanent. Despite the fall in maternal mortality, pregnancy is still an uncomfortable, awkward, sometimes debilitating, and dangerous thing to go through.

    I’ve known women who got diabetes from the pressure on their pancreas, one woman who almost died from organ failure, and one who spent several months on bed rest (often resulting in losing ones’ job, and certainly in a major loss of income).

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  8. TK says:

    @PaulD

    You also seem to forget that there is a hierarchy of desirable children. Exactly how likely do you think it is that a couple with the resources to support a pregnant woman in the hope of adopting her child would do so if they knew she was a crack addict living in the ghetto? Please do read any code words you like into that. Not everybody is willing to adopt any child. In fact, agencies are quite careful about the matching process.

    http://www.washingtonpost.com/wp-dyn/content/article/2006/12/22/AR2006122201166.html

    http://www.blackvoices.com/black_lifestyle/love_features_advice_dating/directorypg/canvas/_a/black-adoption/20060620124709990001

    These two articles are fairly hopeful, but they’re also realistic. What they neglect to mention is the number of children who still wind up in foster care of one kind or another or institutionalized.

    Your cavalier attitude about pregnancy and the realities of adoption is irresponsible, uninformed and insulting.

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