Motherhood, It's Complicated

A colleague on maternity leave recently e-mailed saying what an incredible experience pregnancy is and how she can't help thinking of the millions who go through it without support we take for granted.
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A colleague on maternity leave recently sent an e-mail saying what an incredible experience pregnancy is and how she can't help thinking of the millions of women who go through it without the support we take for granted in the U.S. "Here I am focusing on tummy time and music groups; talk about perspective when you consider that more than half a million women die every year during pregnancy and childbirth because they don't have access to the simplest of health services and supplies."

I had a similar moment of awareness after the birth of my daughter in 2007. I enjoyed a relatively easy pregnancy until my 32nd week when I was diagnosed with preeclampsia (a dangerous condition related to high blood pressure that is one of the top causes of maternal death worldwide). I was monitored accordingly and induced at 36 weeks. A friend asked if I had been administered magnesium sulfate, a compound used to treat preeclampsia. I was not, but her question reminded me how complicated maternal health supplies issues can be.

For 10 years Population Action International (PAI) has been at the forefront of the Reproductive Health Supplies Coalition, a global partnership working to ensure that all people in low- and middle-income countries can access and use affordable, high-quality supplies to meet their reproductive health needs. And while PAI has long recognized the role of family planning in improving maternal health, a specific focus on maternal health supplies emerged in 2009, when PAI partnered with the Maternal Health Task Force. The Task Force asked us to explore who was taking up the issue of maternal health supplies and if PAI could share lessons learned from our reproductive health supplies experience.

Our maternal health research is currently underway, starting with two country case studies in Bangladesh and Uganda. What we have already learned is humbling:

  • Unlike family planning, there is very little direct donor funding for maternal health supplies. The shift to broader health sector and direct budget support, as well as financing from national governments' own resources, means maternal health issues can fall prey to other priorities in a budget process.
  • Women and their families are often expected to pay out of pocket for essential maternal health medicines, such as oxytocin for post-partum hemorrhage, even when government facilities are supposed to provide free health care. This adds another obstacle for poor women in efforts to ensure safe delivery.
  • No coordinated system exists for maternal health supplies in many countries and they are often not integrated into supply systems for other drugs, such as for family planning or newborn and child health.
  • Furthermore, human resource issues -- having staff positions filled, ensuring providers are trained, and particularly being able to improve maternal health at the community level for the women who deliver at home -- are a tremendous challenge. Ensuring sufficient access to supplies alone is not enough when a health system is broken.

It is no wonder that Millennium Development Goal 5 -- improving maternal health-- is the most off track of all the millennium development goals.

These early findings remind me of the truth of my colleague's e-mail -- how much we take for granted. I am expecting my second child in June and it is not lost on me that access to family planning services and supplies has allowed me to delay childbearing until desired, and afforded our family the chance for proper birth spacing. It's more than the miracle of the pill. It's the fact that I can find the pill, afford it, and switch between brands to find one that suits me best. These facts form part of my daily motivation to mentally and emotionally connect to the real lives of the women and families. Over the long term, we at PAI are looking to achieve the Millennium Development Goal on maternal health, and adequate supplies are critical for this to happen.