Maternal mortality is one of the shocking failures of development and a dreadful social injustice. According to recent UN official figures, 536,000 women die every year during pregnancy and birth. This is one death every minute. Out of the 536,000 maternal deaths, 99% are experienced by women in developing countries. The highest maternal mortality rates are in Africa; with a lifetime risk of 1 in 16. Maternal death is often the result of policy decisions that directly or indirectly discriminate against women. Maternal death is also often an indication of inequalities between men and women in their enjoyment of the right to the highest attainable standard of health. Below I illustrate how other rights are either implicated by or essential in combating maternal mortality.
Maternal mortality rates reflect disparities between wealthy and poor women, and between developed and developing countries. [i] Frequently, whether women survive pregnancy and childbirth is related to their social, economic and cultural status. The poorer and more marginalized a woman is, the greater her risk of death. [ii] Ninety–nine per cent (99%) of maternal deaths occur in developing countries, and most of these deaths are preventable. [iii]
While worldwide maternal mortality has declined – in 2013, the global maternal mortality ratio (MMR) was 210 maternal deaths per 100,000 live births, down from 380 maternal deaths in 1990 (a 45 per cent reduction) [iv] – unfortunately in Kenya maternal mortality has decreased very little, i.e., from 490 to 400[v] in the period between 1990 and 2013, compared to the Millennium Development Goal No. 5 (MDG) target [vi] of 147 per 100,000 births. [vii]
International Day of Zero Tolerance for Female Genital Mutilation: 6 February 2015
February 6 – the International Day of Zero Tolerance for Female Genital Mutilation – is dedicated annually to making the world aware of the harmful effects of female genital mutilation or cutting (FGM/C) and to promote its eradication. FGM/C involves the partial or total removal of external female genitalia; a deep form of discrimination against women and girls, it directly violates their right to health, and physical integrity. The practice is rooted in cultural and religious beliefs of communities who perceive it as a social obligation to control female sexuality and ‘preserve or protect’ a woman’s chastity.
The most common form of FGM/C in Eritrea is ‘infubulation’. During the procedure, the child’s legs and hips are tied together to limit movement – often for several weeks afterward to allow healing. The age for circumcising of a girl varies amongst cultural groups, but can range from one month old to 15 years. A traditional circumciser commonly performs the act within communities; close relatives or neighbours can also act as circumcisers.
It is a universal and timeless reality that women face the risk of death in the process of giving life. In recent years, this risk has been virtually eliminated for those who have access to the necessary prenatal care and emergency medical assistance. Contrary to the global trend, Zimbabwe has seen a stark increase in its number of maternal deaths and currently sits with a figure that is 50% higher than the sub-Saharan average.
This state of affairs is not surprising in light of the disintegrated nature of Zimbabwe’s public health system, which reached its lowest point in 2008. At that time, government policies led to the closure of public hospitals and a medical school in Harare. Basic resources and emergency care have not been consistently available and the government’s failure to remunerate healthcare professionals with set salaries left many of them with no choice but to leave the country. The continuing epidemic of deaths which could have been prevented indicates an alarming disregard for a variety of rights and obligations on the part of the Zimbabwean government. Questions arise as to whether the government is taking appropriate measures to address the plight of Zimbabwean women.
Sometime in May 2013, the Republic of Kenya, together with two of her counterparts, Zambia and The Gambia, received the prestigious Resolve Award from the Global Leaders Council for Reproductive Health. Briefly, the Resolve Award was launched in 2011 as an annual award issued by the Aspen Institute. The Award recognises countries that are surmounting various challenges to bring essential reproductive health services to their people and celebrates progress made by governments towards delivering on the promise of universal access to reproductive health. We must therefore begin by celebrating our nation’s achievement. Indeed, impressing a Council comprising of 18 sitting and former heads of states amongst others, the Honourable Mary Robinson, Her Excellency Joyce Banda, Honourable Gro Harlem, Vice Admiral Regina Benjamin and Honourable Tarja Haloren is by no means an easy step.
The Award comes at an opportune time when mothers all over Kenya are celebrating the reprieve granted by the Jubilee Coalition which on 1 June 2013 issued a directive waiving all fees payable by mothers for maternal services at public health facilities. In recent times, we have in addition seen other efforts by the Kenyan government aimed at transforming access to reproductive health services and lowering maternal mortality. First, there is the constitutional recognition of reproductive health as a fundamental human right under Article 43(1)(a). There is also the enactment of many visionary policies and guidelines, including the National Reproductive Health Policy and the comprehensive Population Policy for National Development which places family planning at the centre of Kenya’s development agenda. Additionally, there is also the Child Survival and Development Strategy and the National Road Map for accelerating the attainment of the Millennium Development Goals (MDGs) related to maternal and newborn health in Kenya.