March 8th is observed around the world as International Women's Day -- an opportunity to reflect on many aspects of the well-being of the world´s women including health.
It is also an opportunity to break out of the silos and through the barriers that practitioners and advocates alike have generated in the hope of pushing our own priority causes.
The happy reality is that women do not live in silos. We experience a range of needs -- health and other -- that span across our lifetimes and across generations.
This brings me to reflect on two terms that I and other public health advocates use frequently, particularly around International Women's Day, to focus attention and mobilize action for women's well-being -- "maternal health" and "maternal mortality."
These terms have been used almost exclusively to refer to the health of women at the time of childbirth. Granted, the days in which a woman gives birth to a child are among the most dangerous of her lifetime -- particularly for poor women in developing countries like Afghanistan, who face a lifetime risk of dying during pregnancy and childbirth as high as one in 11, compared with only one in 31,800 in a high-income country like Greece. It is unconscionable that women die in childbirth. But it also irks me that the word "maternal" is often used in public health circles as if it applies only to the time when women are pregnant or giving birth. A woman's job as a mother, and the challenges she will face in this key and difficult role, may begin on those very few and unique days when she gives birth. They definitely do not end there.
Maternal health: Felicia Knaul with her daughter, Mariana Havivah (Maha), celebrate a happy moment during Felicia's treatment for breast cancer.
Yet, we have focused on the idea of eliminating preventable deaths in childbirth as if that were enough. Well, it is not. Guaranteeing that women survive giving birth and then allowing them to die of other preventable causes shortly thereafter -- I purposefully do not define what "shortly" means -- is also an unconscionable failure. A waste. A travesty. It is a failure for the woman, for her family, and for her community. Indeed it reduces the success of the original intervention to close to zero.
One of the greatest recent successes in public health has been the reduction in deaths in childbirth of women in low- and middle-income countries. Recent data from the Institute for Health Metrics and Evaluation show a 35 percent drop in deaths between 1980 and 2010. Still, every year some 287,000 women continue to lose their lives trying to give birth to others, 99 percent of them in low- and middle-income countries.
Contrast this with other diseases that kill young women in developing countries. Today, according to data from the World Health Organization, more than 430,000 women aged 15-59 die each year of breast cancer, cervical cancer, or diabetes.
What is the message here? As my husband, Julio Frenk [Dean of the Harvard School of Public Health], has often taught me, we are victims of our successes. This is true in public health, but also often in life. If, and as, we live through and overcome problems, we are blessed with opportunities to face new challenges.
What should the statistics on the causes of death of women in developing regions say to us? That the world must live up to and build upon its successes to many ways:
First, by continuing to reduce mortality in childbirth -- no woman should die a death that could have been prevented in the moment of giving life.
Second, by meeting the new challenges of diseases that previously did not plague as many poor women (and mothers), simply and sadly because they did not live long enough to experience them. This means converting diseases that today are a death sentence for almost all women in poor countries and communities into chronic illnesses with which these women can live long and productive lives as daughters, sisters, wives, and mothers.
Third, by acting on the recognition that prevention is not enough. Many women experience chronic illnesses for which there is no known or preventable cause. Dare we abandon them? Further, living up to global health success means breaking down the stigma, discrimination and machismo that often force women with chronic illness -- including mental health issues -- into a state of perpetual suffering. Here, I am reminded of another phrase from my husband, when writing about why women do not get adequate or timely care for diseases like breast cancer: the real cancer is the gender discrimination that held them back from seeking care.
I write this piece as I fly to see my own mother. With her health suddenly deteriorating, I am facing the stark reality of a transition, a turn in the maternal life cycle. I can no longer look to her as the maternal, nurturing figure; increasingly, inevitably, it is now my turn to be maternal for her.
I have been incredibly lucky: she is 89 and I am 46. Yet, in addition to my deep sadness, I feel my childhood, or at least my youth, is slipping away, even being stolen from me. Is it that I do not want to ever grow up? No, that is not the crux of what I am feeling. I have my own daughters -- aged 16 and 8 -- and I have lived through another gauntlet of maternal health, fighting breast cancer to ensure that I am with them for as many years as I possibly can be. What I am feeling, what I have learned, what I am sharing, is that women can never, ever have enough healthy maternal years of life.
Felicia M. Knaul is associate professor at Harvard Medical School and director of the Harvard Global Equity Initiative, where she serves as secretariat co-chair of the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries. She writes a regular, monthly blog for the Huffington Post about the challenges of inequity in global health and about innovative approaches to improving quality and access to health care for poor countries and populations.