Maternal mortality in Africa: a gendered lens on health system failure

Paula Tibandebage, Maureen Mackintosh

Abstract


The 2005 report of the UN Millennium Project Task Force on Child Health and Maternal Health, and subsequent UN reports on maternal health, make grim reading. With barely five years to go to 2015, the target set for the fifth Millennium Development Goal, reducing the Maternal Mortality Ratio (MMR -- the ratio of deaths from childbearing to all live births) by three quarters between 1990 and 2015 -- remains far beyond the reach of many low-income countries. To achieve a reduction of 75 per cent, the annual decline in the MMR between 1990 and 2005 should have been 5.5 per cent. With the actual average annual decline estimated at less than 1 per cent over these years, it is apparent that many countries cannot reach the target.  Worse, the average annual decline to date masks huge global inequalities. WHO data show an especially alarming situation in low income countries. In Sub-Saharan Africa, the MMR has been declining on average by only about 0.1 per cent a year.  Why is this happening? What does this terrible crisis of maternal mortality and associated ill health tell us about the state of health systems in much of Sub-Saharan Africa? These very high maternal death rates are not only a crisis requiring urgent attention; they also provide a ‘gender lens’ that illuminates the discriminatory gendered structure of health systems and health policy, and tell us a great deal about the roots of the crisis in the economics of health systems.

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