Becoming a mother in sub-Saharan Africa is more dangerous than climbing Mount Everest. In Chad, the odds of dying during pregnancy or childbirth are one in 15; in Sierra Leone, one in 21.
Around the world, 800 women die every day from largely preventable causes while they’re pregnant, giving birth, or just after they’ve had a baby. But that’s partly good news: Around 25 years ago, the number was almost twice as high.
In 2000, the world set a goal to reduce easily preventable maternal deaths around the world by 75% compared to 1990. We fell short. Some countries, like Chad, made less progress than others. Still, the fifth Millennium Development Goal helped drive massive progress: Maternal deaths have dropped 45% around the world.
“The 75% decrease was aspirational, and it showed–most countries have not achieved it,” says Ana Langer, director of the Women and Health Initiative at Harvard University. “But although MDG 5 was not achieved as a global average, big progress has been made.”
The problem is particularly hard to solve because it’s tangled up with many other ongoing issues. “Maternal mortality or maternal health is rooted in social determinants that are far from solved,” Langer says. “Poverty, gender inequality, violence, conflict, lack of access to quality care. Those are long-term issues that we definitely have not solved yet.”
A new target–achieving universal access to reproductive health by 2015–was added late, in 2005. “In a sense it’s always been playing catch-up to the rest of the Millennium Development Goals,” says Karl Hofmann, CEO of PSI, a nonprofit that works on maternal health issues. “And why is that? I think it’s partly because of patriarchy. It’s partly because these are issues where there’s sexism involved, and there’s just a long history of underinvesting in women’s health.”
Still, the Millennium Development Goal helped focus more attention–and money, from organizations like the Gates Foundation–than ever before. Countries started tracking maternal health that never had that data in the past. A new UN group started following up with countries, keeping them accountable.
“Obviously the MDGs were far from perfect,” says Langer. “But they represent a big change in terms of global health.”
As the world moves forward with the UN’s next set of goals, Langer suggests many things can be improved. “A big one is inequality,” she says. “To some extent, whatever was achieved for MDG 5 was the low-hanging fruit. But there is so much more that needs to be done to improve inequality between countries and within countries. The most vulnerable parts of the population have not been reached.”
Countries can also do a better job of connecting related programs–like linking health care for mothers and children together, rather than focusing on narrowly focused goals. PSI, for example, helps women get contraception when they come into health clinics in Mali with their newborn babies. “Simple approaches like that really weren’t tried so much before,” says Hofmann.
Despite the scope of the problem, Langer is cautiously optimistic about the future. “We have never seen such a mobilization of international organizations, global donors, governments, as we are seeing now,” she says. “So without trying to be naive here–I’m fully aware of the big challenges–I’m optimistic.”