Page last updated at 23:27 GMT, Sunday, 6 July 2008 00:27 UK

Viewpoint: G8 'must make birth safe'

As the G8 summit in Japan opens, Carolyn Miller, chief executive of the medical aid agency Merlin, argues for a push to cut deaths during childbirth in the developing world.

It is often said the health of a nation can be measured by its women. Yet one woman dies in childbirth every minute.

Woman and child in DR Congo

Half a million women die in childbirth each year, entirely unnecessarily - nearly all of these deaths could be prevented if the women had access to a skilled birth attendant.

The leaders of the world's richest countries at the G8 summit have an opportunity to change this.

The Millennium Development Goals, agreed at the UN summit in 2000, set a target of cutting maternal mortality in the developing world by a third, by 2015.

Halfway to the deadline, we are badly behind. The G8 leaders must get us back on track.

They must commit to investing in countries where rates of maternal mortality are highest.


Nearly half of the women who die in childbirth each year live in 46 fragile states - countries where the government is unable or unwilling to support the needs of its people.

Whether emerging from a decade of civil war or recovering from famine or disease, these countries have limited resources.

Too often the funding available for aid to fragile states is for short-term programmes only.

Per 100,000 live births, in 2005
Afghanistan: 1,800
DR Congo: 1,100
Mali: 970
Bangladesh: 570
India: 450
Russia: 28
Uzbekistan: 24
UK: 8
Switzerland: 5
Sweden: 3
Source: Unicef, The State of the World's Children

This is short-sighted.

Only by committing to improving maternal mortality in times of crisis as well as stability can we reduce the number of women who die in childbirth.

The key to reducing rates of maternal mortality is increasing access to good health care.

Rates of maternal mortality are directly associated with attendance of skilled birth attendants. Countries with the lowest maternal mortality report over 98% attendance by a skilled birth attendant. Those with the highest rates of maternal mortality report less than 60% attendance.

Without a trained, experienced midwife on hand, women are more likely to die from complications including bleeding, infection, unsafe abortion, high blood pressure and prolonged or obstructed labour.

Food or health?

In the Central African Republic, maternal mortality levels stand at 1,100 per 100,000 live births, among the highest in the world. Not surprising when you consider that in one district there is just one midwife for 55,000 people.

In Sri Lanka we give midwives motorbikes, in DR Congo we give them canoes, in Afghanistan, we give them a donkey
More than a decade of insecurity has led to chronic neglect of the health care system.

Staff have not been paid for months. Health centres are crumbling. Drugs are in short supply. People have to pay for health care and women will often have to travel for miles to receive the care they need.

As food prices rise around the world, many will have to decide whether to feed their family or pay to see a midwife.

It is often a choice between life and death.

At Merlin we do everything to ensure trained midwives can get to pregnant women and have the right skills. In Sri Lanka we give midwives motorbikes. In DR Congo we give them canoes. In Afghanistan, we give them a donkey.

The G8 leaders must make it their priority to fund lasting change. They must help governments to build capacity: train health workers, pay their salaries and impress the importance of seeking good health care.

In Afghanistan, Merlin set up a midwife training programme in the remote, mountainous Takhar province.

In just 18 months we gave local women the skills they need to deliver babies safely in their communities. The midwife school is contributing to a successful national strategy.

A survey recently completed by the Johns Hopkins University in Baltimore found that up to 40,000 infants are saved each year across Afghanistan due to the increased presence of skilled birth attendants.

One death per minute

It would be wrong to say fragile states do not receive funding. In 2006 they received $12bn (6bn) of overseas aid and the levels have increased over time.

However, nearly half of this was dedicated to Sudan and Afghanistan, leaving the remaining 44 fragile states to split the rest between them. The Central African Republic received just $600m.

With dedicated long-term funding, NGOs such as Merlin can work with governments to set up midwife training schools helping to bring life-saving midwifery skills to communities.

It is impossible to set up these projects with short-term funding.

As the G8 summit begins, time is running out to meet the Millennium Development Goals.

The impact of the delay? Every minute a women dies during childbirth. During the three-day, 72-hour summit, another 4,320 women will have died giving birth.


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