While the decrease in the maternal mortality ratio reported yesterday by the Lancet is a victory, it is anything but a "mission accomplished." We are not off the hook--the same report also documented that HIV is responsible for more than 60,000 maternal deaths each year. The US--whose maternal mortality rate ranks 41st in the world, tying with Serbia and Montenegro--still has a responsibility to prevent maternal death. No woman should die giving birth, in the US or abroad. We have the technology and medical knowledge to prevent it. It's just a question of making sure everyone has access to it, which is, irrefutably, a basic human right.
Further progress in reducing the global maternal mortality ratio cannot be achieved without an aggressive shift towards comprehensive health programs that integrate HIV interventions and maternal health care. Currently, U.S. global health policy addresses HIV, maternal health, and family planning separately, which ultimately pits the issues against each other. Given the Lancet's research results, it also affects whether or not we can truly stem the spread of AIDS and reduce maternal deaths. These health issues have demonstrated that they have no regard for programmatic boundaries. Corresponding policy needs to do the same.
Smart U.S. foreign policy investments must address HIV and maternal health with integrated and coordinated programming. Anyone accessing HIV treatment must also have access to voluntary family planning and other reproductive health services, such as family planning, prenatal care, cancer screening and treatment, and safe abortion services. Effective U.S. global health policy must be:
- Integrated and coordinated: Health issues do not respect programmatic boundaries.
- Woman-centered: Stemming global health epidemics depends on addressing the disparate conditions that put women at higher risk for poor health.
- Multi-sectoral: Poverty alleviation, education promotion, food provision, housing support, job creation and training, and environmental protection all contribute to positive health outcomes.
- Human rights-based: Health programs must respect individuals' autonomy and agency, ensuring that services are provided free from discrimination, coercion, and violence.
- Accessible: Health services must be youth-friendly, and financially and physically accessible.
Reducing the maternal mortality ratio means honestly confronting the reality of illness. The decrease in the maternal mortality rate does not justify a decrease in attention, urgency, or funding. Rather, it requires a strategy that meets the needs of those it affects. HIV and maternal mortality have demonstrated that they are linked. U.S. policy needs to respond accordingly.
For further analysis of U.S. global health policy from Serra Sippel, see Obama's Global Health Initiative: Getting it Right the First time Around, or see our website www.genderhealth.org.