Overheard......from the Organization for Economic Cooperation and Development

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As world leaders meet in New York September 20-22, 2010 to review progress towards the Millennium Development Goals (MDGs), the Organization for Economic Cooperation and Development (OECD) reflects on “Gender Inequality and the MDGs: What are the Missing Dimensions?

How is women’s physical security linked to maternal mortality?

Countries where social institutions are highly discriminatory towards women tend to score poorly against the human development targets used to track progress towards achieving the Millennium Development Goals (MDGs)… .

Women’s physical security, inside and outside their homes, is compromised by various forms of harmful traditional practices and violence against women throughout the world. Not only does this have physical and psychological consequences for women and girls, but it can also reduce their access to health services, and can limit their ability to negotiate safe motherhood. Where women are victims of violence or are subjected to female genital mutilation (FGM), they are at a much greater risk of experiencing complications or death during pregnancy and delivery.

Maternal mortality is on average higher in countries where women are more discriminated against with regards to their physical integrity. In the ten countries where women’s physical integrity is least protected (Mali, Somalia, Sudan, Egypt, Sierra Leone, Ethiopia, Liberia, Guinea-Bissau, Eritrea, Guinea), maternal mortality ratios are on average twice as high as elsewhere. However, the two key measures of women’s physical integrity – violence against women and female genital mutilation (FGM) – are overlooked in MDG 5, despite clearly playing a role in the rate of maternal mortality… .

Maternal mortality in Sierra Leone is reported to be 2 100 per 100 000 live births, one of the highest rates in the world. This can partly be explained by the widespread poverty and limited health services available for much of the population – only 43% of births are attended by midwives or skilled birth attendants. However, evidence shows that there is also a relationship between women’s physical insecurity and the high prevalence of both violence against women and harmful traditional practices. FGM is practised widely throughout Sierra Leone, with the incidence reported to be as high as 85%, and it has a negative impact on women’s health and welfare; it also contributes to the high level of maternal mortality witnessed in the country. Cultural taboos and a failure to prioritise women’s health and safety mean that too often, women are compelled to bear children and give birth at home without access to adequate healthcare.

Widespread violence against women is exacerbated by a weak judicial system and a culture of tolerance for these crimes, although recent legal reforms offer some hope for improving the protection of women’s health and rights.

Reducing the incidence of violence against women and FGM can prove to be an effective way to considerably increase the chances of a safe motherhood. For example, FGM and forms of violence against women such as rape can cause obstetric fistula, an injury that occurs due to prolonged and obstructed labour, and that can also lead to stigma and marginalisation within the community. The risks of haemorrhage and infection during childbirth can increase, and other problems such as low birth weight can be more prevalent. Many women also face an increased risk of violence during and after pregnancy, illustrative of the low value placed on women’s lives.

Although FGM in particular is linked to deeply embedded cultural traditions and practices, it is possible to transform attitudes and reduce the practice in countries which also have a high maternal mortality ratio. For example in Senegal, a community-led initiative, Tostan, has worked with communities to educate, empower and enable them to make decisions about FGM while taking the welfare of girls into account. Over the past decade, more than 70% of the 5000 communities estimated to practice FGM in Senegal have decided to abandon the practice.

In advance of the upcoming MDG Summit, many governments have highlighted maternal health as a priority issue, recognising the links between the survival of women and the health and welfare of their children. While addressing poverty and access to health services are critical to safe motherhood, empowering women to have control over their own bodies and taking firm action to promote their physical security would also be a major step towards realising MDG 5.

To learn more: Investing in Women and Girls: The Breakthrough Strategy for Achieving all the Mdgs (OECD, June 2010)