The position of maternal health as an international priority has changed a lot in the last twenty years. In 1985, leading medical journal The Lancet published an article titled “Maternal Mortality – A Neglected Tragedy: Where is the M in MCH [maternal and child health]?” Since then, maternal health became a major topic of global advocacy and one of the eight Millennium Development Goals.
With its increased prominence came new problems: instead of neglect, maternal health was plagued by rivalries about how to measure it, attempts by pro-abortion groups to politicize it, and persistent suggestions by family planning groups that maternal health can be best improved by avoiding childbearing in the first place.
The international focus on maternal health has been eroded further by acronym expansion: we’ve gone from seeking the M in MCH to trying to excavate it from the clutter of SRMNCAH. And just as it would seem that maternal health could not be diluted any further by competing priorities, The Lancet just published a comment calling for the word “maternal” to be redefined into incomprehensibility.
According to the proposal, defining “maternal” as pertaining to pregnancy, childbirth, and the postpartum period is too limiting:
“[I]t is restricted by its exclusive focus on the risks of bearing children. It does not consider the health of women who are not mothers, the many other problems that lead to premature death and disability, or the multiple roles women have in all societies. Furthermore, deaths associated with pregnancy, childbirth, and the postpartum period represent a decreasing fraction of women’s overall burden of disease.”
That’s right: we can’t exclude non-mothers from the definition of “maternal.” Why not include men too, while we’re at it? Furthermore, if we redefine what “maternal” means as a health category, wouldn’t we need a new word to encompass the very specific causes of death and injury that pertain to pregnancy and childbirth? Why not leave “maternal” alone and refer to more holistic women’s health issues as, say, “women’s health”?
Of course, it’s not just about the language, although it does not bode well for health—especially at an international, multicultural level—if we’re constantly redefining the words that are supposed to unite us around a shared agenda. If, as the quote above implies, maternal health is a solved problem, we can move onto other problems without applying the label “maternal.” Only it isn’t a solved problem: the Lancet article admits that maternal mortality remains a major cause of women’s deaths in sub-Saharan Africa, and preventable maternal deaths are most frequent among the poorest women.
The main thrust of the article is that we need a greater focus on non-communicable diseases (NCDs) as a women’s health issue. While I don’t disagree with that, I do disagree with the authors’ implication that we need to redefine “maternal” to do so. From the article:
“NCDs are now an internationally recognized health priority with a growing global movement. Yet, little has been done to develop systemic responses to NCDs and women’s health or to integrate these two global health agendas and approaches. An integrated, comprehensive approach to maternal health across the life cycle, that makes use of existing health financing, infrastructure, cost-effective interventions, and programmes could help to address these gaps.”
And there we have the key to the whole argument: there’s a lot of global funding and programming directed at maternal health, and everyone else wants a piece of it. Predictably, this avaricious ploy is draped in the language of rights and justice:
“It is unacceptable and unethical to prevent a woman from dying in childbirth, yet to allow her to die of a preventable or treatable condition such as cervical cancer or diabetes.”
There are two obvious problems here: first of all, we have not yet solved the whole “dying in childbirth” thing, so it’s way too soon to be rolling out the “Mission Accomplished” banner. The money and effort being directed at maternal health still has work to do, so it’s not time to cannibalize it, no matter how important NCDs are.
Second, who’s stopping the NCD community from organizing their own funding and programming? There’s nothing unethical about specialization, either in medicine or in development. Who exactly is being criticized for preventing a death in childbirth, yet “allowing” the woman to die of something else?
The authors of this piece want to “push maternal health well beyond pregnancy and childbirth.” To accomplish this, they propose to redefine words into meaninglessness and raid the coffers of programs that are still struggling to achieve much-needed gains for the poorest mothers and children.
“It is time to rethink what is maternal about maternal health,” conclude the article’s authors. If the world takes them seriously, the answer is “not much.”