Maternal death rates improve but hurts fund raising

by Mike Himowitz

When you’re advocating for a health cause, can good news be bad news?

It’s entirely possible — when science threatens fund-raising, and at the worst possible time.

Consider a study of worldwide maternal death rates by a team from the University of Washington that appeared online recently in The Lancet.

The group, led by Christopher Murray, of the school’s Institute for Health Metrics and Evaluation, estimated that there were 342,900 maternal deaths worldwide in 2008 (uncertainty interval 302,100 to 394,300), down almost 35% from 526,300 deaths in 1980 (uncertainty interval 446,400 to 629,600).

The researchers reported that the global Maternal Mortality Rate decreased from 422 per 100,000 live births in 1980 (uncertainty interval 358 to 505) to 251 deaths in 2008  (221 to 289).

Even if one accepts the highest uncertainty level, it would appear that maternal deaths were are least 25 percent below the 500,000 a year that women’s health advocates and U.N. agencies had been estimating for decades.

True, the improvement was still running considerably short of the 75% reduction in maternal mortality established as a 2015 target in the United Nations’  Millennium Development Goal 5.

“But the overall message, for the first time in a generation, is one of persistent and welcome progress,” Lancet editor Richard Horton, MD, wrote in an accompanying editorial.

(In the United States, Maternal Mortality Rate actually increased over that period, but that increase was largely attributable to changes in recordkeeping, Murray and colleagues concluded.)

It wasn’t the first time a new study (and this one ostensibly had access to more and better data than previous efforts) had challenged the conventional wisdom, or a previous study in the same journal. In fact, The Lancet published a study in 2007 that estimated total maternal deaths at almost 536,000 worldwide.

But Horton was obviously perturbed enough about the reaction to the latest research to include a note about it in his editorial:

“Even before the paper by Hogan et al was submitted to us, we were invited to “delay’ or ‘hold’ publication,” he wrote. “The justification for this concern was several fold: potential political damage to maternal advocacy campaigns; confusion among countries, policymakers, and the media, given the difference between this maternal mortality estimate and the previous U.N. number; undermining progress on global commitments to maternal health; and the risk of an unproductive academic debate while women continued to die.”

The real problem: the timing.

Another report, by the Partnership for Maternal, Newborn and Child Health an advocacy group under the World Health Organization umbrella, argued that progress in maternal health had lagged, citing an estimate of 350,000 to 500,000 deaths annually. It contained a call for $20 billion a year between now and 2015 to save women and children in developing countries.

Meanwhile, public health experts were expected to meet with international leaders already assembled in New York this week for the Nuclear Security Summit to take up a new U.N. initiative on maternal and infant health. There are plans for a similar meeting in Washington in June.

Women’s health advocates have been planning to make big pitches for increased funding at these gatherings, and although no one will argue that maternal mortality is a problem of the past, it’s always easier to ask for money when the media aren’t full of good news about it.

In any case, Horton didn’t buy the argument, and according to some reports The Lancet actually accelerated publication of the article.

“Although well-intentioned, these requests to slow the pace of scientific discussion for political considerations are likely to be far more damaging than fostering a serious debate about progress in reducing maternal mortality as and when new data appear,” Horton wrote.

“Is the global health community unable to accommodate diverse voices and sources of evidence? Is it unable to create constructive ways to bring scientists and policymakers together to reach agreement about the meaning of new research findings?”

Mike Himowitz is Deputy Managing Editor at MedPage Today and blogs at In Other Words, the MedPage Today staff blog.

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