19 April 2010

Two Views on Improvements in Maternal Health

Last week I noted a New York Times article which discussed how improvements in maternal health were not welcomed by some who worried about the effects of the news on the perceived urgency of the problem. Some advocates went so far as to try to influence the process of peer review to keep the good news out of sight (sound familiar?).

Today's New York Times has two letters (of four total on the original article) that continue to display these very different perspectives. The first is from Mary Robinson, a former president of Ireland and United Nations high commissioner for human rights:

New data on maternal mortality looks like encouraging news but is hardly cause for celebration.

Only 23 nations are on track to reach the United Nations Millennium Development Goal on reducing by three-quarters maternal deaths by 2015. Real progress will require tackling discrimination against women, increasing resources to strengthen health systems to ensure universal access to care, including through skilled birth attendants and emergency obstetric care, and expanding access to family planning.

Lack of reproductive choices for women, child marriage, sexual violence, exposure to unsafe abortions and the inability to own property are all linked to slow progress on achieving this and other Millennium Development Goals, commitments governments pledged to meet at the start of this century.

The new evidence is encouraging, but must not be allowed to undermine the urgency of addressing maternal mortality and health as a basic human right.

The second is from Dorothy Balaba Byansi, a doctor from Kampala, Uganda:

Your article about the Lancet report on declining maternal mortality brought me so much joy. I work for a Ugandan N.G.O., PACE, where we manage a network of 100 partly franchised clinics, and I’m accustomed to grim stories of “little progress,” even after loads of hard work to ensure that women in Uganda have better access to lifesaving services and products. It is therefore encouraging that the efforts health workers put in across the world are bearing fruit.

In Uganda, though there remains a long mile to walk, we are making progress, too. In 2009, PACE’s partnership with the Ministry of Health enabled 13,686 women to receive long-term family planning methods, up from 255 the previous year. We also distributed 12,420 clean delivery kits and 17,926 Misoprostol doses for the prevention of post-partum hemorrhage, which accounts for one-third of maternal deaths in most parts of sub-Saharan Africa.

Whether you come down on the side of Robinson or Byansi, or better yet, if you realize that multiple valid perspectives on the significance of the Lancet study can co-exist at the same time, we should all be able to agree that trying to shape a political message by intercepting research before it is published is just a bad idea.


  1. I strongly agree that pressure by an advocate for “intercepting research” before its publication to further enable that advocate’s political message is a bad idea, especially if that advocate may be an author of traditional information which conflicts with the new research.

    Recall, the New York Times reported that The Lancet editor, Dr. Richard Horton, declined to name the advocates. However, it also reported, “[The new research from the University of Washington and the University of Queensland, funded by the Bill And Melinda Gates Foundation] was based on more and better data, and more sophisticated statistical methods than were used in a previous analysis by a different research team that estimated more deaths, 535,900 in 2005. The authors of the earlier analysis, published in The Lancet, in 2007, included researchers from Unicef, Harvard, the World Bank, the World Health Organization and the Johns Hopkins School of Public Health. The World Health Organization still reports about half a million maternal deaths a year, but is expected to issue new statistics of its own this year…A spokesman for Unicef said it had no comment on the new findings, and there was no response to messages that were left late Tuesday for W.H.O. officials.”

    Given that the WHO has traditionally issued reports of maternal deaths higher than that found by the new research, I am not surprised that UN high commissioner for human rights Mary Robinson sees the new research as potential for “[undermining] the urgency of addressing maternal mortality and health as a basic human right”. I will be surprised if the WHO issues this year a traditional report without clearly explaining its differences with that new research.

    Given that the interests of the Bill And Melinda Gates Foundation (at http://www.gatesfoundation.org/Pages/home.aspx ) are in promoting education and health and in overcoming hunger and poverty in developing countries, perhaps it should consider funding closer examination of environmental and climate change issues. It would then have to be prepared for whatever "pressure", if any, may come.

  2. Positive stories like these are manna from heaven if you work in this area.

    I have been working for years for a small charity producing free education materials and there is little remuneration and many sad stories so when the good ones come along it does make it feel like your efforts are worthwhile.

    Also listen to Mervyn Kings talk at the Royal Society's 'Handling uncertainty in science' - he shows how to build integrity by being as honest as possible rather than trying to spin information - something politicians like Mary Robinson seem incapapble of doing which is why we hardly ever believe what they say.

  3. This is mentioned at about the 33 minute point of this talk by Ridley on his book 'The Rational Optimist'.