The largest absolute numbers of maternal deaths occur among the 40–50 million women who deliver annually without a skilled birth attendant. Most of these deaths occur in countries with a total fertility rate of greater than 4. The combination of global warming and rapid population growth in the Sahel and parts of the Middle East poses a serious threat to reproductive health and to food security. Poverty, lack of resources, and rapid population growth make it unlikely that most women in these countries will have access to skilled birth attendants or emergency obstetric care in the foreseeable future. Three strategies can be implemented to improve women’s health and reproductive rights in high-fertility, low-resource settings: (1) make family planning accessible and remove non-evidenced-based barriers to contraception; (2) scale up community distribution of misoprostol for prevention of postpartum hemorrhage and, where it is legal, for medical abortion; and (3) eliminate child marriage and invest in girls and young women, thereby reducing early childbearing.
The fifth Millennium Development Goal has brought critical attention to the unacceptably high burden of maternal mortality and the need to improve antenatal health care. However, many of the approaches to reducing maternal mortality (e.g., increasing the number of deliveries at health facilities with skilled attendants or improving access to emergency obstetric care) are complex and will take time to implement. In the meantime, maternal mortality can be reduced relatively inexpensively by preventing unwanted pregnancy through family planning. The decision to practice family planning is personal and private, and it need not require professionals or health clinics. Although inexpensive at the program level, however, family planning may be difficult for individuals to afford. Thus, women face barriers, including cost, lack of transportation and the fear of side effects (real or rumored). In developing countries, making contraceptives available and accessible may be the most important, cost-effective and easily accomplished primary health care goal. Reducing barriers to family planning may lessen the burden of maternal death in low-resource settings.
A look at abortion from the perspective of a doctor who has performed abortions, a physician who also has a PhD in embryology, and someone who had the privilege of working all over the world in various aspects of human reproduction and sexuality.
The largest investments in AIDS prevention targeted to the general population are being made in interventions where the evidence for large-scale impact is uncertain.
Published in Science 2008 May 9;320(5877):749-50