Family planning needed for all women

Dr. Angele Petros-Barvazian, Director of the WHO's Family Health Division in Geneva, outlined a strategy for the survival of mothers during the FIGO congress, at a plenary session on Maternal Mortality and Safe Motherhood. Of the estimated 500,000 women who die each year from causes related to pregnancy and childbirth, 99% are from developing countries, she said. The main causes of maternal mortality are postpartum hemorrhage and unsafe abortions, which go untreated because of a lack of obstetric services. But the underlying reasons for poor reproductive health are rooted in social and economic factors which affect women from childhood on, she explained. Teenage pregnancy, which carries a higher risk of mortality for both mother and child, is far more common in developing countries than in the industrialized nations. The rate in Japan is just 2%, compared with 56% in Malawi. If the age of pregnancy and marriage were delayed through family planning, this would not only save lives, but would also allow girls more time for education. Since family size falls in line with the rise in mothers' standards of education, improved education would contribute to population goals and enable women to play a more productive role in society. We see no contradiction between reproduction and a productive social role. Other important factors affecting women's reproductive health are nutrition and maternal care, she told the meeting. The populations where women's nutritional requirements are not met during pregnancy and lactation, this is frequently reflected in a high proportion of low birth weight babies. Maternal care also has a major effect on maternal mortality. Dr. Petros-Barvazian quoted the example of a small US community in which healthy women refuse all maternity care on religious grounds, and which consequently has maternal mortality rates almost as high as among unhealthy women in developing countries. Summing up, she said that the WHO strategy for the survival of mothers requires social equity and improved education for all women. For women of reproductive age, what we need is improved reproductive health and in particular, family planning for all. For pregnant women, we need improved prenatal and maternity care for all, with facilities for obstetric care for high-risk cases. Socially, we need to ensure that social and cultural relations are supportive to women in their roles as mothers to children, and not just as pregnant women. If we improve the social status of women, we will improve mortality and fertility; and the reverse is also true.