Remaining challenges overshadow progress.
In 2002, the United Nations released its eight Millennium Development Goals for worldwide health and education. The fifth goal is improving reproductive health and reducing maternal mortality by 75% by 2015, but progress has been slow and that target won't be met, according to a Lancet series, Women Deliver. A conference of the same name was held in Kuala Lumpur, Malaysia, in May.
Figure. A nurse dres...Image Tools
Countries that fail to invest in maternal health are missing an opportunity for development. Women make up 40% of the global labor force, and both high fertility rates and maternal deaths lower family income. Girls who stay in school earn higher wages, and educated women have lower fertility rates. Investing in women's health, especially reproductive health, helps break the cycle of poverty.
The Lancet series reveals several challenges that remain.
* A lack of access to contraception for 222 million women worldwide, especially in Africa and Asia, is a continuing problem. Contraception averted 272,040 maternal deaths in 2008, and filling the unmet need for contraceptives could prevent 104,000 deaths each year.
* Increasing public education programs could decrease ignorance, increasing the use of modern contraceptives.
* Better targeting of funds is needed. A review of aid disbursement in 2009 and 2010 found that 54% of $2.2 billion earmarked for reproductive health went for treatment of women with HIV. Only 7.2% went to family planning, even though family planning helps prevent HIV infection and deaths.
* Volunteer peer counseling by women's groups, a neglected yet cost-effective strategy for improving maternal and children's health in poor communities, must be expanded. In rural Malawi, for example, such interventions have reduced mortality: maternal deaths fell by 74%; perinatal deaths, by 33%; neonatal deaths, by 41%; and infant deaths, by 28%. The average cost to prevent one year of life lost was only $33.
Rape and sexual violence continue to be major problems, according to a pair of articles in October's Lancet Global Health. In Papua New Guinea, Bangladesh, China, Cambodia, Indonesia, and Sri Lanka, 25% to 80% of men surveyed admitted having committed physical or sexual intimate-partner violence, and between 3% and 27% of surveyed men had committed nonpartner rape (in both surveys, the highest rates were in Papua New Guinea). Among those who had committed nonpartner rape, more than half first did so as adolescents. In the Democratic Republic of Congo, some 40% of women experience sexual violence, according to the June 6 New England Journal of Medicine.
Despite these data, a few bright spots dot the landscape.
* From 1957 to 2010, maternal mortality in Malaysia fell from 540 to 28 per 100,000 live births. The percentage of women delivering babies in safe institutional settings rose from 10% to 98.7% during the same period. More than 4,000 family planning centers offer care across Malaysia today.
* In the United States, the Guttmacher Institute reports the need for contraception that's publicly funded (through Title X or Medicaid, for example) rose 10% between 2000 and 2010. These contraceptive services prevented an estimated 2.2 million unintended pregnancies and saved $10.5 billion, largely by avoiding unplanned births. Without publicly funded contraception, the rate of unplanned pregnancies, births, and abortions would have been 66% higher in 2010.
To stay abreast of these and other issues in women's health worldwide, see the UN Women (www.unwomen.org) and the Guttmacher Institute (www.guttmacher.org) Web sites.—Carol Potera
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