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Maternal mortality: audits, accountability and rights

In early September I participated in a meeting on maternal mortality, human rights and accountability with a diverse bunch of people approaching maternal mortality from their different perspectives, countries and continents, including human rights specialists, health professionals and finance people.

The meeting was organised by a collaborative group of The Clemens Nathan Research Centre, International Initiative on Maternal Mortality and Human Rights, SAHAYOG, CARE Peru, Health Equity Group (East Africa) and Essex University Human Rights Centre.

So why was everyone there? Apart from the fact that the world is still way off track to reaching the Millennium Development Goals, it is also the development indicator which shows the widest inequalities. According to 2005 figures, the likelihood of a woman dying from pregnancy-related causes in the UK is 1:8200, in Sierra Leone and Afghanistan a woman’s risk is 1:8 and in Niger 1:7. Shocking figures.

Even in wealthy countries inequalities become strikingly apparent when we look at maternal mortality. Amnesty International’s recent report Deadly Delivery states that in the USA, where more money is spent on health care than in any other country in the world, the maternal mortality rate has risen from 6.6 per 100,000 live births in 1987 to 13.3 per 100,000 live births in 2006. For African-American women the risk of dying from pregnancy related causes is nearly four times as high as for white women.

Detailed information like this, broken down to show the most vulnerable groups, is vital for addressing planning and tackling inequalities. When this information is shared, people become aware that they are not being treated equally, that their rights are being abused and can act to demand the care they are entitled to.

Ariel Frisancho Arroyo from CARE Peru gave an example of how communities can be involved in gathering this information and acting upon it. Their programme on maternal mortality and citizenship surveillance uses vigilantes who are trained to collect information on maternal mortality and complaints about the health system, analyse the data and follow up. This has led to improvements in obstetric and child health.

Gauri Van Gulik from Human Rights Watch spoke about maternal death audits, stating the importance of a focus on systematic issues and support for front-line health workers. An example was given from the Theni district in India. Audit found that a recurring factor in maternal deaths was health care delays brought about by poor referral methods. When the referrals were replaced with health wokers accompanying the women being transferred to a hospital, this resulted in the women receiving health care on the journey and receiving quicker and more appropriate care on arrival at facility.

These examples show that audits, information and a rights-based, accountable approach can bring about positive changes for women.

But lets not stop there. Save the Children believes the health of a mother and a child to be inseparable. This is why, as a child-focused organisation, so many of our programmes include maternal health.

My colleague Davinia raised this issue at the meeting. The Human Rights Council has a resolution to address maternal mortality. It would be logical and desirable if the link with child survival was also addressed, including the provision of legal and policy guidance.

Save the Children is by no means alone in this wish. Towards the end of the meeting, Dr Flavia Bustreo, the director of the Partnership for Maternal, Newborn and Child Health strongly encouraged this link to be made in all efforts to achieve MDGs 4 and 5.

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