The maternal death rate myth

NEW YORK-Just as leaders convened at the UN headquarters in New York for a conference on maternal mortality, The Lancet published a study that undercut abortion advocates' efforts to link the cause of maternal mortality to abortion rights. At the United Nations Commission on Population and Development, activists used the world's supposedly dismal progress on "maternal mortality" to push for sexual and reproductive health and rights, and more funds for family planning and "safe abortion"-a euphemism for legal abortion.

But researchers from the University of Washington and University of Queensland found that the maternal mortality rate is far less than the 500,000 annual deaths claimed by the UN.

The new study found that maternal deaths numbered 343,000 in 2008, and have declined from 422 per 100,000 live births in 1980 to 251 in 2008. The yearly rate of decline has been 1.3 percent since 1980 and as swift as 8.8 percent in some places, like the Maldives, for an overall decline of over 30 percent in almost 30 years. More than 50 percent of all maternal deaths were in only six countries in 2008, the study showed. As Richard Horton, editor of The Lancet, said, "The overall message, for the first time in a generation, is one of persistent and welcome progress" and "robust reason for optimism."

However, some advocates didn't want the good news out just yet. Horton said they asked The Lancet to delay its publication to avoid political damage to the maternal mortality campaign. He told The New York Times that some of these advocates had the April 12-16 UN Commission on Population and Development (CPD) meeting in mind.

Abortion advocates at the meeting continued to use the old numbers to push for family planning and "safe" (or legal) abortion. The International Planned Parenthood Federation (IPPF) made a statement saying that without significant increases in support for family planning and "safe abortion services," it would be impossible to achieve goals on maternal health. They noted "unsafe abortion" accounts for 13 percent of maternal deaths and said "preventing unwanted pregnancies in turn prevents unsafe abortion."

Thoraya Ahmed Obaid, director of the United Nations Population Fund, said if every woman had access to reproductive health services, including family planning, the world would achieve the Millennium Development goal of 75 percent reduction in maternal mortality by 2015. The Phillippines echoed this with a strong statement for reproductive rights, saying the maternal mortality rate is not dropping fast enough: "Family planning services is the missing link. Mothers will continue to die unless they can substantially have only planned pregnancies." The United States joined in, saying addressing the "unmet need for family planning" would enable the world to reduce maternal mortality.

Peter Smith, chief administrative officer to the UN for the Society for the Protection of Unborn Children, said pro-lifers have long doubted the "500,000 maternal deaths" statistic since not all countries have death certificates. "Unless the number's high, you can't get the money," he said of the push for more family planning funds. "They exaggerate it to push their case." In fact, IPPF complained it would be impossible to achieve universal access to reproductive health-a new target of the Millennium Development goals-with family planning funding halved between 1995 and 2007. The U.S. delegation noted that President Barack Obama has requested from Congress $715.7 million for international reproductive health programs, including family planning, in 2011-the single largest U.S. contribution in history.

Pro-lifers also dispute that legal abortions mean fewer maternal deaths. According to statistics from the U.S. Center for Health Statistics and the U.S. Centers for Disease Control and Prevention, the dramatic decline of abortion deaths in the United States coincided with the use of penicillin and antibiotics during the 1950s, not with the legalization of abortion in 1973.

But ignoring the positive trends, the outcome document produced by the CPD meeting last month complains about the "slow progress" in reducing maternal mortality and names "complications due to unsafe abortion" as one of the leading causes of maternal death. It urges member states to double their efforts to ensure universal access to reproductive health-including family planning of all types-by 2015. But it leaves out one statistic: the exact number of maternal deaths worldwide, instead using the number "hundreds of thousands."

Maternal mortality math

A new study headed up by the Unive­sity of Washington shows maternal mortality has dropped by more than 30 percent in the past 30 years-from over 500,000 deaths annually in 1980 to about 343,000 in 2008.

Six countries now account for more than half of all maternal deaths: Afghanistan, Central African Republic, Malawi , Chad, Sierra Leone, and Lesotho.

Source: University of Washington Institute for Health Metrics and Evaluation