Thursday April 29, 2010

From the Experts: The Keys to Ending Maternal Mortality

By Peter J. Smith

WASHINGTON, D.C., April 29, 2010 ( – Two experts on maternal mortality spoke at a congressional briefing on Tuesday sponsored by U.S. Rep. Chris Smith (R-NJ), a pro-life and human rights leader, explaining the global decline in maternal deaths and why life-affirming maternal care, not abortion, is a practical solution.

According to the World Health Organization, maternal conditions contributed to 1.9 percent of the world’s total deaths in 2004. While the death of the mother is already a tragedy, the tragedy is compounded many times over in societies where mothers take up much of the burden in care-giving for the extended family and members of the community.

“We desire to reduce, if not eliminate, preventable maternal mortality,” said Dr. Bob Scanlon, an obstetrician associated with Maternal Life International who worked and trained maternal health care workers in Africa.

“Pregnant women – be they in the United States or in Africa – face similar medical problems related to pregnancy and childbirth,” said Scanlon, reflecting on his 10 years of experience in Africa, where he repaired obstetric fistula, delivered babies, and trained maternal health care workers.

“I am a board certified obstetrician; my training has taught me why women die in childbirth and how to prevent such problems,” he continued. “I understand what the medical community has known for years: pregnant women die from bleeding, infections, obstructed labor and hypertensive disorders.”

Scanlon said that women in third world nations with high maternal mortality need skilled maternal health care workers trained in safe birthing practices, improved basic medical care, access to education, and retroviral drugs if they are HIV-positive.

He said that maternal mortality began its precipitous decline over the past hundred years in the western world when women started getting assistance in birth from midwives and doctors on a large scale basis and from medical advances, allowing them to have a “safe passage” in the transition from pregnancy to birth.

“How do we provide this safe passage?” said Scanlon. “By training and equipping maternal health care workers.”

Dr. Donna Harrison, president of the American Association of Pro-Life Obstetricians and Gynecologists, augmented Scanlon’s practical experience by highlighting the findings from a just-released study from The Lancet, a British medical journal, which showed that maternal mortality deaths were significantly lower than previously thought.

Harrison in her presentation explained why, contrary to the claims of abortion advocates, the abortion procedure does not reduce or eliminate the life-threatening risk that would otherwise occur to a woman in delivery, and for that reason has no practical benefit toward reducing maternal mortality.

The fact is that in every pregnancy, said Harrison, a woman faces a “window of vulnerability” known as “parturition,” which is the separation of the mother and the unborn child. This includes live birth, still birth, other deliveries (ectopic, molar pregnancy), spontaneous abortion, or induced abortion, where parturition can expose the mother to the danger of infection and excessive bleeding.

The Lancet study “Maternal mortality for 181 countries, 1980 – 2008: a systematic analysis of progress towards Millennium Development Goal 5” showed four main reasons for the improvement in maternal survival: declining total fertility rates in some countries (reducing direct exposure to maternal death), improved economic status (leading to better nutrition, physical health, access to better health care), higher education rates for women, and increasing availability of basic medical care including “skilled birth attendants.”

However, the medical journal never mentioned legal abortion as a factor in bringing down maternal mortality ratios. In fact, pro-life nations such as Poland, Malta, and Ireland had just as low or even lower ratios of maternal mortality than the United States, Norway, and Canada, which all have very liberal abortion laws.

Harrison pointed out that induced abortion actually puts women in danger of bleeding/hemorrhage, infection, and damage to reproductive organs, especially if not all the pieces of the destroyed unborn child are completely evacuated. The risks are even greater for medical abortion, Harrison said, highlighting a study published in the journal Obstetrics and Gynecology, which found that women having a medical abortion had an eightfold risk of bleeding, fivefold risk of incomplete abortion, and twofold risk of (re)evacuation than surgical abortion. The study concluded that medical abortion was likely “to result in an elevated incidence of overall morbidity related to termination of pregnancy.”

In third-world developing countries, the adverse events associated with medical abortion can prove deadly if women do not have medical infrastructure to monitor them when things go wrong.

Instead, Harrison indicated that the key to eliminating maternal mortality as much as possible is getting women educated and ensuring universal access to skilled birth attendants.

Her presentation pointed to the example of Chile which had legal abortion until 1988 and where maternal mortality peaked in 1961. The ratio of maternal mortality continues to decline steadily even after 1988, as women become more literate (98.6 percent by 2007) and with the percentage of births delivered by a skilled birth attendant rising (99.8 percent of births in 2007). By 2007, maternal mortality was 1.7 deaths per 100,000 live births.

“What’s going on is that there are not enough trained skilled birth attendants,” to address maternal mortality in the developing world, said Scanlon in a question and answer session afterward. “Boy, we would be loved in many countries if we trained and equipped skilled birth attendants, but that is not what we are doing.”

“So the mantra is skilled birth attendants, antibiotics, oxytoxic drugs, magnesium sulfate, and a literacy program,” added Harrison. “Female literacy is the key: you train the mom you train the next generation.”