Updated October 13th 10:08pm

There can be no baser connection for all humans than pregnancy and birth. As my friend and women’s health advocate, Heidi Breeze-Harris says, “We all arrive through pregnancy.”

You’d think with this kind of reputation, prioritizing maternal health might be a no-brainer for governments around the world, and for society at large. But so far the cries for our mothers over the crisis of maternal mortality have not been loud enough to create real, lasting change.

According to Women Deliver, a conference and initiative launched earlier this year to mark the 20th anniversary of the Safe Motherhood Initiative (PDF), maternal mortality is defined as “the death of a pregnant woman during her pregnancy or within 42 days of pregnancy termination.” And there has been very little decline in the rate of maternal mortality worldwide over the last fifteen years. Despite the Safe Motherhood Initiative’s global commitment, government promises and the inclusion of maternal mortality in the “Millennium Development Goals” (a set of agreed upon goals crafted by the United Nations member states and international organizations that include reducing poverty, reducing child/newborn mortality, and fighting AIDS around the world), we have not been able to save our mothers.  In this country, we are still waiting for our presidential candidates to recognize the global health of mothers as a critical foreign policy issue  – as an issue worthy of public discussion and debate. Will the fate of mothers be part of our next president’s agenda? Or will the issue remain in the shadows as the shameful secret we all share?

Ann Starrs, president of Family Care International, the organization that helped launch the Safe Motherhood Initiative, and Women Deliver this year says,

“We need significant increases in U.S. funding for maternal and reproductive health and for programs that promote gender equality, and we need those programs to focus on known and effective interventions: family planning and other reproductive health services; skilled care during pregnancy and childbirth; emergency care for women and newborns with life-threatening complications, and immediate postnatal care.”

Breeze-Harris, an advocate for ending obstetric fistula, an entirely preventable childbirth injury occurring almost entirely in developing nations says, “The safety and security of birth must not be yet another of the maternal and women’s health components that is ignored by policymakers, governments, research and aid.”

Alex Allred, the mother of a 3-month old girl, faced a difficult pregnancy. Suffering from high blood pressure and with the threat of pre-eclampsia hanging over her head, Alex needed a c-section and delivered her daughter 3 weeks early. Had she been living in one of many developing nations, her chances of surviving pregnancy and childbirth would have been much slimmer. And she recognizes how crucial it is for our presidential candidates to address this issue in their agendas for reproductive health.

But she isn’t holding out much hope:

“My standards are so low for the presidential candidates on this issue that even for them to acknowledge that there is a crisis – a crisis of maternal health care around the world – would be adequate.”

We allow one woman to die every minute around the world from pregnancy or childbirth complications. We allow ten to twenty million women each year to suffer complications from childbirth that result in lifelong afflictions. Most of the deaths and complications are preventable. Millions of women can be saved with access to basic health care including family planning, contraception and safe abortion. These are the women from whom we came, the women from whom future children will come. And we are failing them; we are failing us.

"No nation, least of all the United States, should look the other way when women die while giving birth for lack of the most basic lifesaving care. Whether in Baltimore or Bangladesh, maternal mortality is the single greatest indicator of the failure of health systems to provide care to society’s poorest and most vulnerable women, said Theresa Shaver, Global Secretariat, White Ribbon Alliance for Safe Motherhood.

And while maternal mortality rates vary greatly from country to country, don’t think for a moment the United States is a model of maternal health. As noted above, the United States currently ranks 41st in the world for maternal mortality. Women here, as women around the world, suffer and die needlessly from complications that are preventable and treatable. According to the CDC, “The leading causes of pregnancy-related deaths in the United States are hemorrhage, blood clots, high blood pressure, infection, stroke, amniotic fluid in the bloodstream, and heart muscle disease.” Racial disparities in the United States reveal themselves in a shocking maternal death rate for African-American women that is four times the rate of white women’s maternal mortality. Economic disparities in the United States ensure that women for whom a safe pregnancy and birth should be guaranteed, where access to care should not be a barrier, are unnecessarily endangered.

Kris Lysaker, mother to two children ages 9 and 7 years old, tells the story of how economics impacted her pregnancy and birth. “I had a very traumatic birth. One that began with a day at home and a day at a birth center before being rushed to the hospital. I was unemployed so was receiving Medicaid. Only because I had the fortitude to complete the masses of complicated paperwork necessary for “low-income healthcare” was I able to finally go to a hospital. I can only imagine that thousands of other women [insurance-less women, not just Medicaid-eligible women], opt out of going to the hospital for fear of the overwhelming cost, and wind up injured – or dead.”

Breeze-Harris has another perspective, however, of what it’s like to birth in the U.S. for many woman as compared to women in developing nations:

“I had an extremely difficult childbirth.  I nearly died…despite the best medical care at a state of the art hospital.  I had an obstructed labor, an emergency c-section and then a second surgery where I had to have [a blood transfusion].  I am lucky to be alive and to have a happy healthy boy. I won the lottery, just by having my baby in the developed world; both my son and I skirted the deaths that would have been our fates in much of the developing world.

“I think we take these things for granted…but in a place like Niger, where 1 in 7 women will die in pregnancy and childbirth, there are just 10 OB/GYNs for a population of 10 million people.”

There are organizations and governments working hard on behalf of women and mothers, including at this week’s UN High Level Meetings on the MDGs. Still it is extremely unlikely we will see anywhere close to a reduction in maternal deaths of that magnitude by 2015 without significant investment from the United States.

Ann Starrs says,  “Improve Maternal Health” is the Millennium Development Goal that is farthest from reaching its 2015 target…Investing in women makes economic sense, and is fundamental to respect for justice and human rights.”

What kind of investment are we talking about?

According to the White Ribbon Alliance for Safe Motherhood, a coalition of 3,500 organizations in 91 countries,

“Experts estimate a package of maternal health services costing less than
US $1.50 per person could make significant improvements in women’s health in
the 75 countries where 95% of maternal and child deaths occur.”

Shaver elaborates, "It is past time for the
U.S. to meet its obligations at home and abroad to participate in
initiatives to reduce maternal mortality with no less urgency than
steps taken to fight the war on terrorism or secure the stability of
financial markets. Not only is an investment in women’s health one that
reaps enormous economic benefits, it is the right thing to do."

The Bush Administration has drastically cut funding for reproductive health care and family planning internationally, over the last eight years, which is one of the reasons for the near stagnation of maternal mortality rates globally.  In addition, President Bush has refused to release over $200 million over the last seven years for UNFPA programs critical to ensuring family planning and contraceptive services for women in developing nations.

But it’s not simply money that is needed to reduce the rates of maternal deaths.

Breeze-Harris says, “We must empower women with voices and choice and education. Educating a girl is the best way to keep her from marrying young, which is the best way to keep her from being pregnant too young, which could save her life…That is the most cost effective way to…stop maternal mortality.”

And according to Women Deliver, the “known and effective interventions” that will save women’s lives include programs and services that our next administration can and should certainly have a hand in providing; family planning, access to contraception, care during childbirth by skilled nurses, midwives or doctors…and education.”

UNFPA has recently launched an initiative that they say could reduce the number of women dying in pregnancy and childbirth by 75%. The initiative is a partnership with the International Confederation of Midwives and calls for an increase of 334,000 skilled labor and birth attendants in developing nations, along with follow up obstetric care. 

“By investing in midwives and universal access to reproductive health, millions of lives can be saved and we can reach Millennium Development Goal 5, to improve maternal health,” said UNFPA Executive Director Thoraya Ahmed Obaid.

International Planned Parenthood Federation estimates that 70,000 women die every year from unsafe or illegal abortions. Over one-quarter of the world’s women live in countries where legal abortion is inaccessible, leaving many women with little to no hand in their own fate. We need to work to ensure legal abortion worldwide.

But Ann Starrs is unequivocal about the United States investment, ““The U.S. government funding for reproductive and maternal health programs overseas has been both inadequate and marred by ideologically-driven restrictions that undermine, rather than promote, public health.”

Our next President has the ability to not simply sign-on to whatever plans have already been lain through the Millennium Development Goals and other global promises to women. Our next administration has an opportunity to take a leadership role on this issue by investing much more in reducing maternal mortality and by encouraging other developed nations to do the same.

Let’s compel the candidates to outline the ways in which they will address the loss of our mothers. We do know that Barack Obama would immediately do away with the Global Gag Rule, though John McCain has not said whether he would our wouldn’t. Obama would also return the more than $200 million Congress has allocated to UNFPA over the years, but that our president has refused to release. McCain has not said whether he would or wouldn’t but Jane Roberts doesn’t believe he would. We have also yet to hear from either candidate whether they support or oppose President Bush’s recent decision to cut critical funding for family planning services to international women’s health center, Marie Stopes, in six African nations. 

What about amending PEPFAR to include significant investments in reproductive health care, family planning and contraception, or a plan for addressing racial disparities in maternal mortality rates in our own country?

As Heidi wrote to me, “Whether you are in Niger or Chad, where they have a saying that pregnancy means you have one foot in the grave, or the U.S., where we are 41st in maternal mortality, an unconscionable statistic when you look at our wealth, we all have to pay attention to pregnancy and childbirth.”