UNICEF’s latest State of the World’s Children annual report (SOWC) focuses on the mothers of newborn babies, who die in their hundreds of thousands each year in the developing world. It is one of the great scandals of the world today that, in spite of 20 years of high-level plans for safe motherhood, an estimated 500,000 women die annually in childbirth or as a result of pregnancy-related complications. Often the infant dies as well and families are left motherless. The immediate causes are very clear: lack of primary health care that is accessible and trained personnel.

However, UNICEF also puts much emphasis on environmental factors such as cultural attitudes to women and girls, particularly early marriages. Worldwide, it says, more than 60 million women who are currently aged 20-24 were married before they were 18, mostly in Africa and Asia. If a mother is under 18, her infant’s risk of dying in its first year of life is 60 per cent greater than that of an infant born to a mother older than 19. As well, an estimated 70,000 young women between the ages of 15 and 19 die in childbirth or from pregnancy complications.

In addition, the report says that adolescent wives are susceptible to violence, abuse and exploitation. Young brides are often forced to drop out of school, have few work opportunities and little chance to influence their own lives.

While there are serious issues of “empowerment” of women that have to be faced, UNICEF’s “gender equity” and “reproductive health” preoccupations suggest why the international agencies have not managed to achieve the necessary breakthrough on maternal mortality. The SOWC report is peppered with references to the essential role of reproductive health services in empowering women and saving their lives. In UN circles this usually includes “safe” (legal) abortion.

When the Millennium Development Goals were set in 2000, Goal 5 was: “Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio.” The main indicator for this would be the proportion of births attended by skilled health personnel. In 2005, however, the UN General Assembly revised the goals and added a new target to Goal 5: “Achieve, by 2015, universal access to reproductive health.” The indicators for this are: the contraceptive prevalence rate (to be increased); the adolescent birth rate (to be reduced); antenatal care coverage of at least one visit and at least four visits (it’s not clear exactly what this involves); and the unmet need for family planning (to be reduced).

It is difficult to judge which part of Goal 5 is receiving more attention. At the very least the UN has complicated its task and presumably divided the financial resources available. ~ The State of the World’s Children 2009, released Jan 15