WHO calls mother-child deaths a ‘massacre’

Each year, half a million women die in childbirth. Nearly 11 million children under 5 die of poverty-related illnesses. On World Health Day, April 7, Dr. Marie-Paul Kieny, head of the World Health Organization’s family health department, called these deaths a “scandal” and a “massacre” as WHO issued its annual World Health Report, this year entitled “Make every mother and child count.”

The report discusses these largely preventable deaths as due to lack of access to life-saving care. It estimates that an increase of $9 billion a year for each of the next 10 years is needed for the 75 countries with the worst outcomes to achieve the goal of cutting down maternal mortality by three quarters and child mortality by two thirds.

Most of the deaths of children under 5 are avoidable through existing interventions that are simple, affordable and effective. They include oral rehydration therapy—a simple drink of clean water with some sugar and salt—for diarrhea, antibiotics for respiratory infections, effective anti-malarial drugs and insecticide-treated netting, vitamin A, promotion of breastfeeding, immunization against measles and other diseases, plus skilled care during pregnancy and childbirth with access to high-tech obstetric care when needed.

Nursing newborn babies immediately after birth and keeping them warm could also reduce deaths in the critical first hours of life. Four million of the childhood deaths occur in the first days and weeks of life.

The 68,000 maternal deaths resulting from an estimated 18 million unsafe abortions performed every year are almost completely avoidable. What’s needed is access to legal abortions using safe techniques.

Out of a total of 136 million births a year worldwide, WHO estimates that trained midwives and doctors deliver less than two thirds the babies born in less developed countries, such as those in Latin America, and only one third in the least developed countries, such as most of Africa.

Lack of access to skilled care and to life-saving interventions—including surgery, blood transfusions, antibiotics and anti-hypertension medication—is the primary reason why large numbers of poor mothers, particularly in rural areas, die in childbirth. Malnutrition in young children makes them die of diseases that would not otherwise be fatal and stunts their brains as well as their bodies.

The report focuses on those developing countries where progress in maternal and child health is slow, stagnating or has even gone into reverse in recent years. The WHO laid most of the blame for those setbacks on the collapse of basic health care, mainly due to conflicts or political strife.

What report doesn’t say

Most of the poorest countries in the world today are rich in natural and human resources, but they have been plundered by colonialism and imperialism. Their political, economic and social structures have been forcibly engineered to meet the needs of foreign lenders, rather than the people. The World Bank’s promotion of user fees and privatized health care has led to reduced access to services for millions of poor people.

Now there is concern that this staggering burden of poverty and illness could undermine the ability of transnational corporations to reap profits from the less developed countries.

In countries directly under attack by the U.S. today or suffering from the ongoing effects of undeclared “dirty wars,” maternal mortality is increasing.

In places where women do not have reliable, woman-controlled methods of contraception, the risk of dying in each pregnancy is multiplied by the many times a woman becomes pregnant. Women in Africa have a 1 in 16 lifetime risk of dying from giving birth.

Cuba is also a country targeted by the U.S., but it has a socialist economy and a wonderful free health system. Cuban mothers have only a 1 in 1,600 lifetime risk of dying in childbirth. Other women in Latin America and the Caribbean have a 10-fold greater risk of death, while African women have a 100-fold greater risk than their Cuban sisters.

In the United States, there are between five and six maternal deaths per 100,000 live births for white women, but the risk is four times greater for African American women.

The WHO report emphasized the need for human resources: doctors, midwives, nurses, technicians and others vital to maternal-child health programs. It noted the disparity between care for rich and poor, in cities versus rural areas.

The shortage of trained personnel is made worse by the “brain drain” in poor countries. Doctors and other skilled health workers, many of whom were educated at public expense, often must emigrate to Europe or the U.S. if they want to find better pay and working conditions. Well-funded non-governmental organizations and foundations compete with impoverished ministries of health to hire health care providers. NGOs may provide much-needed resources, but are not answerable to local people or governments.

Ellen Y. has been a nurse practitioner for over 20 years.