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Bjorn Lomborg is president of the Copenhagen Consensus and a visiting fellow at the Hoover Institution at Stanford University.
Every two minutes, a woman dies of complications related to pregnancy and childbirth. But it doesn’t have to be that way. Most of these deaths are preventable — and the world has been working on a solution for decades. The problem is the funds dedicated to solving the problem never go far enough.
There are inexpensive and effective solutions that could help bring down the number of mothers who die from childbirth. New analysis published last week by Copenhagen Consensus, the think tank I lead, shows how a modest investment of less than $3 billion a year could avert 162,000 maternal deaths, more than 1.2 million newborn deaths and almost as many stillbirths.
That cost is less than a tenth of the more than $30 billion advocacy organizations typically ask for, which would save only a fraction more lives.
The tragedy of pregnant women and their children dying has long been on the global health community’s radar. Twenty years ago, the United Nations promised to address the issue with the Millennium Development Goals, but not enough progress has been made.
Since 2000, maternal deaths have declined about a third, from 451,000 a year to about 295,000 today. But the world community had committed to reducing such deaths by more than two-thirds by 2015.
The latest target, set in the 2015 Sustainable Development Goals, is to bring maternal deaths down to 100,000 a year by 2030.
Commitment without action won’t save pregnant women and their children. It takes financing and simple medical procedures.
Mothers in the hardest-hit developing countries — predominantly in Africa and South Asia — are still 80 times more likely to die than their counterparts in the richest countries. Their newborns also perish; last year 2.4 million children died during their first 28 days of life. They die because many women either give birth in their own homes, without access to skilled birth attendants, or in facilities with limited basic emergency care. The mothers die of infections that result from low hygiene and high blood pressure that can lead to seizures. Severe bleeding that can happen after childbirth kills 46,000 mothers every year.
Many proposals have been put forward on how to address this global crisis, but trying to eliminate every single problem related to maternal health in all low- and middle-income countries would cost over $30 billion per year, and it is unlikely that such funds can be raised.
Our new research uses cost-benefit analysis to determine which policies would be most cost-effective at preventing maternal and newborn death during childbirth. The study was conducted by maternal health experts and supported by funding from Merck for Mothers.
The researchers focused on the 59 countries with the highest maternal and newborn mortality rates that account for more than 90 percent of all maternal deaths globally. Using a model developed at the Johns Hopkins Bloomberg School of Public Health, the researchers analyzed more than 30 ways to reduce mortality rates.
While we found all would have an impact, some would help much more per dollar spent. Two interventions stood out as the best investments for new spending. They are straightforward and don’t require cutting-edge technology.
To obtain the greatest impact for investment, health officials and donor agencies should consider focusing on family planning and what is known as basic emergency obstetric and newborn care.
An estimated 217 million women who want to avoid pregnancy still don’t have access to safe and effective family planning methods. If 90 percent of women in the 59 hardest-hit countries had access to such services, fewer would become pregnant and 87,000 fewer mothers would die each year.
Sometimes it’s as simple as getting more mothers into more health facilities while also improving the quality of those facilities. In practice, this means ensuring that adequately trained staff are present with the right equipment and medicines to deliver simple and uncomplicated well-known lifesaving procedures. These include immediate drying and thermal protection of the newborn, assisted vaginal delivery and neonatal resuscitation.
Even such seemingly simple measures come with significant costs. Midwives and nurses have to be educated, recruited and salaried; management expanded; drugs procured; and infrastructure paid for. Moreover, women also have to be given an incentive to give birth in facilities.
Still, implementing basic emergency obstetric and newborn care and family planning is relatively inexpensive, costing just $2.9 billion per year. In economic terms, each dollar spent would achieve $71 of social benefits, making it an extremely smart investment — one that could bring billions of dollars of economic and health benefits to people around the world.
While you read this, at least one more mother died. If the world health community focused on these two affordable interventions, millions of other mothers, and their newborns, would live through childbirth.