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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.