The year 2010 leaves the world with just five years before the targeted achievement of the United Nations’ Millennium Development Goals. Though time will tell if ongoing efforts prove sufficient, the goals of fighting disease, eradicating poverty and hunger, and pushing for environmental sustainability, at least, seem to be on track for success. Reducing gender-skewed death rates is another story. According to 2010’s Millennium Development Goals Report, of the eight goals under discussion, the fifth—that of decreasing the maternal mortality ratio by three quarters and achieving universal access to reproductive health—appears farthest from being accomplished.
The steadily high rates of both maternal and child mortality are thoroughly preventable. Yet the struggle for maternal and reproductive health has been impeded by ideologically driven controversy and persisting gender inequality. Barriers in funding, due in large part to the controversial attitude toward family planning on the global stage, continue to perpetuate a problem that could be solved with sufficient provision of medical care and supplies to women. As such these barriers represent not simply a point of ideological difference, but moreover a world health crisis and a human rights issue of enormous proportions. Worldwide prevalence of unlawful and unsafe abortions causes huge numbers of maternal deaths and, indirectly, the deaths of children who are left uncared for. Low use of modern contraceptive methods leads to further unintended pregnancies and health complications for both women and children, often resulting in families too large to support. Until the world directly confronts these problems, both women and children will continue to die. If world leaders are serious about reaching the Millennium Development Goals targeting maternal and child mortality by the 2015 deadline, it is time to set ideology aside and begin focusing on tangible efforts to increase access to medical attention and reproductive rights worldwide.
Maternal Health, Paternal Ideologies
In his 1999 book Development as Freedom, Amartya Sen denounces the phenomenon by which women in many countries are reduced to “progeny-generating machines.” This reduction, he writes, persists “partly because of the low decisional power of young women in the family and also because of unexamined traditions that make frequent childbearing the uncritically accepted practice.” A considerable obstacle for advocates of reproductive rights, and women’s rights in general, is the continued marginalization of women throughout the world. Manifestations of gender inequality appear in myriad forms, including income inequities, limited economic opportunities, domestic violence, and the stigmatization of women’s participation in major decision-making, whether financial, political, or even personal. In much of the world, women’s voices are stifled by the cultural dominance of men, and as a result, women are often reduced socially and institutionally to their reproductive ability. In control, the men in their lives determine the value of women’s personhood by their frequency of childbearing, and treat them accordingly.
According to Alexandra Garita, International Policy Program Officer at the International Coalition for Women’s Health, the subordination of women often precludes them from obtaining the health care they need. “The root cause of access issues is about women not being able to assert their rights, about the control men have over women’s bodies,” she says, adding that in many parts of Latin America, women have to hide contraceptives under the mattress, fearing a beating if the men find out. “Since we’re taught as women to be docile and submissive, women’s voices are not heard. That itself is a barrier to access.” Stigma and discrimination around women’s sexuality in many communities augment the paradoxical link between silence around sexual behavior and an expectation of many children.
For these reasons, women are often unable to ask for contraception or other family planning services, or even, at times, for medical care during pregnancy. Furthermore, according to the United Nations’ 2010 Millennium Development Goals (MDG) Report, net funding for family planning has dropped since 2000, and progress in expanding the use of contraceptives by women has slowed since the 1990s. As high rates of adolescent and unintended pregnancy abound among women with low levels of education or who live in impoverished or rural areas, as few as one in three women in some developing regions obtain the recommended level of care while pregnant. Thus, the rate of reduction in maternal mortality remains significantly below the 5.5 percent annual decrease required to meet the 2015 target.
This is not only an issue for women. Maternal and women’s health are intricately linked to the success of each of the other seven goals, and to the successful development of nations at the periphery of the global economy. UN Secretary-General Ban Ki-moon has stressed women’s key role in progress worldwide. “For too long, maternal and child health has been at the back of the MDG train, but we know it can be the engine of development,” he said at the April 2010 launch of an initiative for maternal health in developing countries, put forth by a joint action plan linking governments, civil society organizations, and international foundations. Fostering healthy children, he added, will enable stronger, better educated, and more productive world citizens; failing to do so would be unconscionable. "It's just morally unacceptable,” he said. “This is a real human rights issue.”
It may seem obvious that preventing maternal mortality, along with child mortality, is in the interests of governments worldwide. Yet religious and politically conservative objections to family planning,with abortion at the center of the debate, have played a significant role in discouraging funders and NGOs from backing reproductive health. Among early advocates of the reproductive rights movement, however, not abortion, but population control was both the rallying cry and the primary source of contention. Inflamed by Malthusian fears that the world population would soar, policymakers and activists in the 1960s and 1970s urged for efforts to limit birth rates, particularly in developing countries where those rates were highest. Allegations of the imperialist nature of population control—implying that wealthy, developed countries were attempting to wipe out the populations of impoverished nations—fueled the fire against reproductive rights, demonized by critics as a genocidal practice. From the point of view of reproductive rights advocates, the goal of controlling population growth is of course not to suppress populations, but to allow them to flourish by decreasing unintended pregnancies and, consequently, births of children whose parents are unable to care for them adequately. Their advocacy, however, has met with continuous opposition. While altered in form, the debate goes on.
A Solvable Problem
While the abortion debate has hindered progress toward comprehensive reproductive care, many policymakers, world leaders, and funders agree that investing in family planning not only saves countless women’s and children’s lives, but also has a positive global impact on medical, social, and economic levels. “Mothers are the foundation of our society,” said Ban Ki-moon at a press conference in June 2010. “When mothers are healthy, families are healthy…by focusing on the needs of the most vulnerable, we lay the foundation for a more sustainable and prosperous tomorrow.”