The glaring injustice of maternal deaths in Africa

We have the knowledge and resources to end preventable maternal mortality – today. So why are women still dying while giving birth? Because for too many women, a safe birth still depends on a chain of simple, but life-or-death contingencies: whether a family can find transport to skilled care, whether a midwife is on duty, whether the clinic cupboards are stocked. If any links in this chain falter, the consequences can be catastrophic. 

A woman named Mercy recently saw this first-hand: She traveled to a clinic in Zambia’s capital, Lusaka. She experienced a routine labour and a safe delivery. She held her baby in her arms. And then, without warning, she began to bleed profusely. 

That condition, post-partum haemorrhage, is the world’s most common cause of maternal death, but there are many others, from dangerously high blood pressure to infections. Every day, on average, more than 700 women die from causes linked to pregnancy and childbirth. 

And in Africa, these risks are multiplied to a staggering degree. On this continent, a 15-year-old girl has a 1 in 57 chance of dying while pregnant or during childbirth; for a girl in Australia, that risk is 1 in 21,000. Africa accounts for 70 per cent of all maternal deaths globally. That isn’t a health gap, it’s a moral chasm. 

Just 7 African countries are on track to meet the global goal on reducing maternal death. This is not a failure of science or clinical know-how. It is a failure of systems, and a failure to sustain high-level commitments.

Beyond aid: A new public health order

The truth is that, with timely access to quality supplies and healthcare, most maternal deaths are avoidable. A woman does not die because we cannot save her; she dies because the ambulance has no fuel. Because the supplier was not paid on time. Because supplies are sitting in a warehouse instead of a clinic. Because the medicines are expired. Because staff training has been delayed.

The links in Mercy’s chain of contingencies were, thankfully, unbroken. Her clinic in Lusaka was part of the UNFPA-supported SafeBirth Africa initiative, where midwives are equipped with the tools and skills to quickly diagnose the severity of post-partum bleeding and initiate life-saving treatment.

Every woman on the continent deserves to benefit from that kind of care. And it is possible with the African Union’s New Public Health Order, which shifts the continent away from donor-led procurement and towards a unified, African-led agenda. That means coordinated disease control led by the Africa Centres for Disease Control and Prevention and regulations harmonized by the Africa Medicines Agency. It means the production of quality-assured medicines by Africa’s own dynamic pharmaceutical manufacturers and a strengthened African health market championed by the African Union Development Agency. It means the creation of robust intra-African supply chains, and partnerships with the UN and others to ensure monitoring and accountability. 

The global battle against maternal mortality will be won or lost in Africa. We have the research, the technical expertise and the roadmap. What we need now is to unite behind Africa’s public health leadership.

Africa’s future is the future of the world

This is the world’s youngest region, with nearly one third of the population between the ages of 10 and 24. Their future – and the world’s future – depends on Africa’s ability to address these systemic failures now. 

We do that not just by disseminating health commodities and building supply chains but by understanding mothers and their children as the inseparable link from one generation to the next. When a mother is able to give birth safely, her children can thrive – a process that starts even before her child is born, when she is able to access family planning, antenatal care and safe delivery services. It continues into the life of the child, as she is able to access healthcare, education, and an unfolding universe of possibilities. 

But those services do not appear by wish alone. Health sovereignty, the genuine ability of a nation to decide and deliver care for its own people, requires financing sovereignty. Maternal mortality is not only a health service delivery issue, but also a matter of budgetary fiscal space and careful public financial management.

As much as this is a moral and social argument, it is also an economic one: When a mother dies, her potential contribution to the economy, her labour, her innovation, her enterprise dies with her. The cost of inaction is staggering and quantifiable: A recent Lancet Commission showed that failure to invest in maternal and child health could lead to productivity losses amounting to $3.8 trillion by 2035. On the other hand, every dollar invested in family planning can yield up to $27 in economic benefits, and broader investments in maternal health deliver substantial returns. We see clearly that the failure to act is the most expensive choice of all. 

If we are serious about building healthy generations and a sustainable future for the continent, we must ensure that childbirth is a safe, empowering experience that secures the future for every woman and her family.

Co-authors:

H.E. Ambassador Amma Twum Amoah, African Union Commissioner for Health, Humanitarian Affairs and Social Development

H.E. Ms. Nardos Bekele-Thomas, CEO of the African Union Development Agency, AUDA-NEPAD

Mr. Claver Gatete, UN Under-Secretary-General and Executive Secretary, Economic Commission for Africa

Ms. Diene Keita, Executive Director of the United Nations Population Fund