For too long the answer to making childbirth less dangerous has been to urge women to avoid it. The family planning establishment, backed by powerful Western governments, has saturated the global market for contraception, yet more than 300,000 women still die every year in childbirth. It is time to release the stranglehold that family planning has on international maternal and newborn health care programming.
The first step is making sure that we have the metrics right in particular, what it means to save a life.
Ending preventable maternal and child deaths is a priority for the World Health Organization, the U.S. government, and global partnerships between governments, UN agencies, and the private sector. Large disparities still exist between countries’ maternal and infant mortality ratios and rates, which measure the relative safety of birth and infancy by counting deaths against the number of live births. Mortality rates are higher among poor and rural women, but there are gaps in the collection of birth and death statistics in many of the areas most in need of help.
Meanwhile, family planning groups that tend also to promote abortion have positioned themselves within the maternal and child health movement, arguing that their services are the most effective and affordable way to end preventable deaths of mothers and children.
Following the logic of groups like the Guttmacher Institute, if contraceptive use were increased, a certain number of pregnancies would be prevented. Based on the existing maternal and child mortality rates in a given region, a small percentage of those pregnancies would result in a death in childbirth or infancy. Therefore, the mother’s life is saved by preventing her pregnancy—and the child’s life is saved by preventing his existence.
This approach has several critical flaws. Even in the poorest countries, maternal and child deaths are relatively rare occurrences, so a much larger number of pregnancies would have to be prevented to avert a single death. This aligns well with the goals of family planning groups, whose primary motivation is fertility reduction, but less so for maternal and child health efforts.
If “deaths averted” becomes an accepted measurement of progress, as proposed in the pending U.S. bill called the REACH Act, preventing pregnancies could increase its status as a preferred approach to reducing deaths. Perversely, the higher the risk of death in childbirth, the more lives could be claimed as “saved” by preventing pregnancy. Thus, essential resources could be diverted away from the interventions that make pregnancy safe for mother and child.
Where pregnancy and childbirth are unsafe, the risk of death and disability falls on all mothers, regardless of whether they became pregnant intentionally or not. While family planning groups envision being able to dramatically increase contraceptive use by increasing access, the reality is that lack of access is already extremely low in developing regions. Furthermore, even in highly-developed countries with high contraceptive use, such as the US and the UK, nearly half of all pregnancies are still classified as unintended. The difference is that in those countries, pregnancies and births, intended or otherwise, rarely entail a risk to the mother’s life.
Ultimately, the world needs policies that treat the complications of childbirth and infancy, not policies that treat childbirth and infancy as complications.
Keeping funding and programming for maternal and child health separate from family planning and abortion is an important way to prevent safe pregnancy and birth from being a luxury only the wealthiest countries can afford.