Institute of Development Studies

Can someone tell me how babies are made?

Kate Hawkins - 11 March 2009

Having worked in the field of sexual and reproductive health for some time now it may come as a surprise to learn that I am feeling increasingly confused about the causes of pregnancy.

The last couple of years have seen a resurgence of interest in improving maternal health. This is to be welcomed as about 500,000 women die in pregnancy or childbirth every year - one a minute – and 99 per cent of these deaths occur in developing countries. However I am struck by the increasing conservatism of maternal health advocates and policy makers. Forget ‘sexing up’ the issue – to make maternal health politically palatable it seems that pregnancy is increasingly being divorced from its root cause. It is quite possible to read articles in serious newspapers or speeches from high profile advocates which contain no mention of sex at all.

The complications that account for 70 per cent of all of maternal death and ill health are haemorrhage, infection, high blood pressure, unsafe abortion, and obstructed labour. For many women having a skilled attendant during delivery and access to obstetric care is quite literally a matter of life and death. But listening to prevailing narratives on maternal health one can end up assuming that women only desire and require access to health services once they are pregnant. And that access to clinical services to make childbirth safer is the only way in which lives can be saved.

Health system strengthening

If we are serious about reducing the numbers of women who die in pregnancy and childbirth we need to strengthen health systems. On the strength of the web story I wrote for International Day of the midwife last year perhaps I could also be accused of occasionally making sex invisible in maternal health framings! But this is a dangerous approach which can lead to some strange policy, financing and programmatic decisions which don’t serve women, their families, communities and national health budgets well.

Two interventions that could make a real difference to maternal mortality figures are access to family planning and safe abortion services.

Sexual and reproductive health and rights

The Department for International Development states that, ’32 per cent of maternal deaths could be averted through family planning. It is one of the most cost-effective interventions in public health. Research has shown that every US$ million spent on family planning can avert 360,000 unwanted pregnancies, prevent 150,000 induced abortions and save the lives of 800 mothers and 11,000 infants.’

Unsafe abortion accounts for an estimated 13 per cent of maternal deaths – and it leaves many more women unwell or disabled. Recent research on the economic costs of abortion from the Realising Rights Research Programme Consortium ‘Economic Impact of Unsafe Abortion-Related Morbidity and Mortality: Evidence and Estimation Challenges’ suggests that the cost of unsafe abortion-related morbidity and mortality to health systems is around $500 million. This is without factoring in those women who never access health services to treat abortion complications and the losses to the economies of developing countries brought about by lower productivity.

The international community appear to agree that reproductive health is a development priority. After a great deal of concerted advocacy we now have a new target under Millennium Development Goal 5 – to ensure universal access to reproductive health by 2015. We also have a US Administration which is making increasingly positive noises about sexual and reproductive health and rights. The time is ripe to meaningfully bring policy on sexual and reproductive health and maternal health together.

Moving forwards

Perhaps we could even go further and give some more thought to how sexuality and sexual rights relate to maternal health. For example, this might mean a focus on the choices and wellbeing of women living with HIV, the need to tackle sexually transmitted infections like syphilis, tackling gender based violence and a consideration of the needs and rights of sexual minorities.

We used to have an International Development Minister who stated confidently and repeatedly that ‘People shouldn't die because they have sex.’ Every time I heard it I gave a little shiver of pride in the progressive policy that guided the UK Government’s work on sexual and reproductive health and rights. As the UK Department for International Development begin the process of updating their policy on maternal and sexual and reproductive health we have a great opportunity to generate that kind of excitement once more.

Kate Hawkins Communication Officer for the Health and Social Change Programme at IDS