Jill Sheffield, 61, the founder-president of the New York-based non-profit, ‘Women Deliver’, has helped put the deaths of ordinary women in childbirth on the international agenda through a combination of indefatigable campaigning and targeted public education.
For her, battling maternal mortality is about a very simple idea:
Protecting Women’s right to live.
Q: You call yourself a public educator. Why have you chosen to educate the public on maternal mortality?
A: Well, women are the heart of development. If we don’t pay attention to them, we are not going to make any gains on poverty reduction because it is women who bring major social and economic benefits to their families and communities. In order to make the progress on the Millennium Development Goals (MDGs), and indeed just in terms of human rights, if we don’t make sure that women survive something as simple as pregnancy and childbirth it means that their communities and families are not going to thrive either.
Q: So high maternal mortality levels reflect the way society treats women?
A: Precisely. Women in many societies are not valued. Women do so much more than deliver babies. That is why the name of our organisation is important: ‘Women Deliver’. People need to change their attitudes about what it is that women deliver. Babies is one thing, but they also deliver work, water, clean food and income to the family. We now know women’s deaths and disabilities related to child bearing entail lost productivity of 15 billion dollars every year. This is criminal.
Q: So there is a link between maternal mortality and the lack of value given to women’s work.
A: The number of women in waged work is growing. But women also contribute unrecognised labour. An awful lot of them are in unremunerated work. In the United States, half of the work force is now women, and something like 85 per cent of all women with children under six are in the workplace. This is a huge resource for our national economy. And this is as it should be. Why shouldn’t women work? They have a significant contribution to make. When people talk about solutions, I always feel the biggest solution we can have is the education of girls. It is an expensive solution, true, but it has real impacts in the long term. Incidentally, I started life as a schoolteacher and my mother was one, and teaching is about the most noble profession there is.
Q: You have seen the situation in so many countries. Is there anything in common between India and, say, Nigeria?
A: I worked in east Africa for a number of years. One thing is clear, rural women everywhere are much more disadvantaged than urban women. They lack supporting mechanisms, like schools, hospitals and they lack access to health care and contraceptive services. It is a fact that unintended pregnancies have a higher rate of complications that require services that are non-existent. There are 215 million sexually active women in the world today who don’t have any access to contraceptive care.
When you work out how many women die in both India and Africa, it is way too high. They share the same common denominators such as lack of services, lack of equity, conflict areas. The difference, of course, is India’s large numbers. The actual situation is Africa is really bad: one woman in every six is destined to die from mainly preventive causes. In India, the rate is much better, but the numbers are huge. According to the latest estimates, there is one maternal death every seven minutes in India. Maternal mortality is beginning to decline, but even by conservative estimates 3,50,000 maternal deaths every year is nothing to be proud of. So we need to improvise on the World Health Organization (WHO) slogan and say: Make Every Woman Count.
Q: Will the MDG Goals 4 and 5, dealing with infant and maternal mortality, be reached?
A: Well, we are going to have to really press. I am not sure the world is going to fully meet both goals, but I know that if we do not meet MDG 5 we are going to fall short on the others as well. The good thing is that there is huge progress. In June we held the ‘Women Deliver’ conference and put the G-8 and G-20 on notice: We told them that it is crucial they make resources available for dying mothers. Then we had the Africa Union Heads of State meeting. They renewed the Maputo Plan of Action, which is a really big step. Then there are the Millennium Development Goals. One of the great things about them is that they do not put one country in competition with another; they put every country in competition with itself. So those numbers need to come down in competition with past performance, in order to make the future different.
Q: Given the emphasis on institutional births, what role do you see for the traditional birth attendant?
A: The WHO did a really interesting study looking at four interventions which they thought would be the answer: They trained traditional birth attendants to wash their hands; they gave them new razors so that they wouldn’t use glass or old knives; they gave them a surface on which to place the woman for her delivery; and they had a sterile string to tie the chord. Infection rates went down, but maternal mortality levels stayed the same. Across the world, whether it is in New Delhi or New York, three per cent of all pregnancies will have a complication. Statistically, 15 per cent of pregnancies end up with a life-threatening complication. This is what causes high maternal mortality rates. If a woman is in the care of a traditional birth attendant and is one of those 15 per cent women, she is probably going to die, because those sorts of complications cannot be handled by such attendants. They require special skill sets, blood transfusions, caesarean sections, treatment for toxemia, a post-partum haemorrhage – which, in fact, is the most serious. Now we have drugs, which stop this bleeding. I think institutionalised childbirth is a longer term investment, and that we have to move to it. I personally believe that we need skilled providers who can access whether a patient requires institutional care.
Q: What about the promise of technology in addressing maternal mortality?
A: I think the mobile telephone technology has a lot of promise. For one, the woman can be in touch with people and health providers. There is a new programme called text4babies. Every week they send out important messages to expectant mothers about how they can take care of themselves, what the danger signs are, immunisations, post-partum depression, nutrition, the works. It can also connect health workers with district hospitals.
In the old days in America, in the Appalachian mountains, there was something called the Kentucky Nursing Service. First these carers went on donkeys, then horses, then jeeps, then four-wheel drive vehicles. The latest version is the mobile, and they have computer links to teaching hospitals.
I think we are only limited by our imagination!
By arrangement with WFS