Managing Motherhood, Managing Risk: Fertility and Danger in West Central Tanzania

3. The International Community: Making Motherhood Safe from Afar

CHAPTER 3 The International Community: Making Motherhood Safe from Afar It is the purpose of this Conference to heighten awareness and concern among governments, agencies and non-governmental organizations about the neglect of women’s health, particularly in the developing world, and to elaborate strategies to remedy this desperate situation. We do not pretend to have all the answers, but we do believe that we have the scienti‹c knowledge and the means to cut maternal mortality in half in the next ten years at a cost affordable to most developing countries. In order to strengthen the hand of those responsible for health care we will examine together how best to apply this knowledge in order to make pregnancy and childbirth safe for all the world’s women. —Joint statement issued by the World Bank, WHO, and UNFPA on the occasion of the ‹rst Safe Motherhood Conference, February 10–13, 1987, Nairobi, Kenya The agendas of major development donor institutions are made to seem like the only possible way to deal with problems of poverty and social inequality. Faced with the moral discourse of “saving lives,” we have to be careful to distinguish between evaluation of the medical initiatives being promoted and evaluation of the actual social and institutional means through which these medical techniques are introduced . . . Relations of power, as well as states of health, are at stake in health development encounters. —Stacy Pigg, “Acronyms and Effacement” Since the mid-1980s, international attention has increasingly focused on the high levels of maternal mortality in the Third World. This new attention to maternal health was itself an outcome of the United Nations’ “Decade for Women 1976–1985,” a decade in which women’s issues were made visible through the volume of research generated about women during that period (Escobar 1995; Kabeer 1994; Ong 1988; Royston and Armstrong 1989).1 One result of this new gaze directed toward women was the increased attention paid to maternal mortality.2 35 In chapter 2, we examined the risks of motherhood as they were de‹ned by colonial administrators and missionaries working in the Tanganyikan health-care setting. In this chapter we turn our attention to how maternal health risks were de‹ned in the Safe Motherhood Initiative. WHO and the Safe Motherhood Initiative In the industrialized countries maternal deaths are now rare: the average lifetime risk for a woman of dying of pregnancy-related causes is between 1 in 4000 and 1 in 10,000. For a woman in the developing countries the average risk is between 1 in 15 and 1 in 50. These countries commonly have maternal mortality rates 200 times higher that those of Europe and North America—the widest disparity in all statistics of public health. Why have these inequities in maternal death rates only recently become apparent and a cause of grave concern to governments and to WHO? The main reason is that until lately the size of the problem was largely unknown. —Dr. Halfdan Mahler, Director-General of WHO, The Safe Motherhood Initiative Much of the literature produced during the ‹rst decade of the Safe Motherhood Initiative included the disturbing statistic that 500,000 women died every year from complications associated with pregnancy and childbirth, and that approximately 99 percent of those deaths occurred in developing country settings.3 One WHO publication puts those 500,000 maternal deaths in “real” terms: Every four hours, day in, day out, a jumbo jet crashes and all aboard are killed. The 250 passengers are all women, most in the prime of life, some still in their teens. They are all either pregnant or recently delivered of a baby. Most of them have growing children at home, and families that depend on them. (WHO 1986:175) Similar to the story of Mrs. X, this vivid image of a plane, ‹lled with 250 women, crashing every four hours, catches the reader’s attention, making the hard-to-conceptualize number of a half-million deaths of women easier to grasp. It also helps underscore the point that women in the developing world face incredible risks every time they become pregnant. As noted by the Director General of WHO above, a primary concern of the Initiative was the disparity in maternal deaths between rich and poor countries. Maternal death rates attempt to measure a woman’s risk 36 Managing Motherhood, Managing Risk of dying from a given pregnancy in a particular country...