Mother’s Day is an opportunity for us to honor our own mothers and the mothers around the world who birth, feed, nurture, and teach their children.
It is also an opportunity to reflect on the fact that motherhood should be a choice. All women should have access to information and tools to prevent pregnancy so they can plan their families, or not have children at all. Planned pregnancies are not only women’s right, but lead to healthier children and mothers in the longer run. Pregnant women who decide to continue their pregnancies should have access to prenatal care and safe labor and delivery services, and women who need or want to end their pregnancies should have access to safe, high-quality abortion services.
In recent years, many countries have put a renewed focus on maternal health as they work toward the United Nations’ Millennium Development Goal (MDG) 5, which calls for reducing maternal deaths by 75 percent by 2015. Most developing countries, however, will not meet their targets by the deadline. Even though such deaths are almost entirely preventable, 358,000 women still die each year.
Leading causes of maternal death include hemorrhage, infection, hypertension, and obstructed labor. But another prominent—and entirely preventable—cause is often ignored, unsafe abortion, which is responsible for 13 percent of maternal deaths. Discussions about maternal mortality that refer to “death in childbirth” ignore unsafe abortion—and it’s hard not to conjure images of women lovingly caring for their young when the term “maternal” is invoked.
The term “maternal health” allows us to ignore the 47,000 women who, lacking access to safe options for an abortion, take matters into their own hands or visit an untrained provider in order to end their pregnancies—and die as a result. Many of these women are already mothers, and their deaths are equally as devastating to their children, families, and communities as those of the women who planned to continue their pregnancies.
Many donors and leaders avoid unsafe abortion, calling it a “divisive” or “politically sensitive” topic, which serves to further marginalize the issue. The truth is that we have simple technologies for women who want or need an abortion and improving access to safe abortion services saves women’s lives and health system dollars. Decision-science models have found that life expectancy in Ghana and Nigeria would increase if women had any form of a safe abortion instead of an unsafe abortion.
The first and best way to help women avoid unsafe abortion is by improving access to contraception. Research has demonstrated the life- and cost-saving potential of increasing access to contraception — and here we have some good news. After being neglected for many years, family planning seems to be making a comeback, with the Bill and Melinda Gates Foundation among the donors directing new support to this area. In July, in partnership with the government of the United Kingdom, the foundation will host the Family Planning Summit, which aims to generate unprecedented commitments by donors and governments to family planning and cut the unmet need for contraception in half by 2020.
But just increasing access to family planning will not eradicate the problem of unsafe abortion. Decision-science models have shown that achieving the MDG target of reducing maternal mortality by 75 percent in India, where one-quarter of all maternal deaths occur, would require improving access not only to family planning and care during childbirth, but to safe abortion services as well. Addressing access to family planning and unsafe abortion together leads to faster and larger reductions in maternal mortality than either intervention alone.
We need more advocates who are willing to tackle both the controversial and “safe” causes of the 358,000 maternal deaths that take place each year. Whether a woman risks dying from a botched abortion or from bleeding after childbirth, her life counts and every effort should be made to save it.
Part of the solution is to draw attention to the full range of health risks associated with pregnancy. One small but powerful way to do this is to drop the “maternal” from maternal health and replace it with “women’s.” Such a shift is not mere semantics; moving away from “maternal” health could broaden our view about the spectrum of women’s, including mothers’, sexual and reproductive health needs.
While not all women decide to have children, virtually all are sexually active at some point in their lives. Many become pregnant when they don’t want to be. A more comprehensive and complete idea of maternal, or rather, women’s health, would encompass a full range of health needs that includes contraception, abortion, and care before and during childbirth. This would be a fitting way to honor the choice of motherhood on Mother’s Day.