CONTRIBUTORS
Estelle Monique Sidze
Research Scientist
Despite massive interventions, maternal health statistics in Africa still reveal persistent unfulfilled goals and tasks. But, unfulfilled by whom, should we ask? An African woman’s lifetime risk of dying from pregnancy-related complications is 1 in 39. Yes, 1 in 39, compared to 3000 or more in developed regions. If you believe in the six degrees of separation theory, which posits that people are six or fewer social connections away from each other, you can easily connect the dots from a single woman dying to instability in multiple social networks. As evidenced by dozens upon dozens of pieces of evidence, persistent inequalities in access to quality services coupled with inadequate offer of equitable quality services are to blame for the failure to eliminate avoidable maternal deaths on the African Continent. Maternal deaths are, therefore, seen as the result of social injustice, with the poorest and most vulnerable segments of the population paying the highest price.
I believe that maternal mortality is not merely a social injustice issue, but it also reflects a poorly negotiated and implemented social contract. When I think about the social contract within the maternal health field, I reflect on philosopher Rousseau’s famous quote, ‘’Man was born free, and he is everywhere in chains.’’ This quote deeply resonates with the status of women in the world, who, despite being born free, are bound by society to handle the most controversial gender responsibility of giving birth and to be prisoners of sociocultural norms and practices, discourses, and governments’ actions or lack of action thereof.
The modern discourse on women’s health is currently fuelled by intense debates around what had been branded by multiple international media as ‘’a war on reproductive rights.’’ including issues of human reproduction, contraception, abortion and post-abortion care, sexuality education, and LGBTQ (key population) rights. These highly emotive issues are fiercely debated in a partisan manner. No matter which side you are on these debates, you would perhaps agree with me that we need deeper and more engaging conversations on the same in African countries. The persistent pro-natalist norms and debates in many African countries cast women’s primary identities as child bearers: “Marry and give birth,” they say, no questions asked! This expectation, one without a social contract, of assuming that women must live up to the childbearing role while remaining safe and in good physical and mental health during the process is one of the biggest social scams in our history.
Throughout my career, I have attended several eye-opening international, regional, and local gatherings on maternal, newborn, and child health. These meetings often focus on agenda setting, evidence mining for decision-making, or presentations on research or implementation work by talented solution seekers. What strikes me most in those meetings is the recurring “business-as-usual” approach to things and an egotistical assumption that all the root causes of the problems are known and solutions very easy to implement if money or funding were not the issue. There is also the persistent need to present evidence on the necessity of investing in women’s health using scenarios of lives saved or returns on investments if justifications to do the right thing need to be made. On the other hand, what truly bothers me are the voices of African leaders expressing their inability to do the right thing for all sorts of reasons, often sounding much more like excuses than actual reasons.
So, what is the right thing to do as far as maternal health is concerned? Is it increasing domestic financing for proper action? Is it establishing the right infrastructure and building centers for excellence and referrals for advanced emergency obstetric care (EmOC)? Is it training and motivating highly skilled health providers across all health system levels? Is it equipping women, families, and communities with health information and emergency skills, or is it gathering more data and evidence-building scenarios? From my experience, which I have built over the years by listening to different maternal and child health shareholders, the solutions go beyond all those actions in the African continent. The right thing to do is to build on the motivation to make a change and understand that action on maternal mortality is part of the social contract to women. The key word here is motivation-not accountability, meaning a driving force to pursue a vision goals, overcome challenges, and achieve positive outcomes.
The 2020s decade has witnessed numerous mass protests across different African countries – masses standing against governments’ responses to austerity measures or demanding that their rights to basic needs such as education, work, food, health, shelter, or water be fulfilled. Changes in attitude within various Governments has resulted in significant contributing factors to the 35-year-plus quiet revolution that is transforming women’s education and work worldwide. Beyond implementation, monitoring, surveillance, or progress tracking frameworks, I believe ending avoidable maternal deaths would need ending the current status quo or social order in favor of innovative frameworks delineating rights and responsibilities between governments and women and common ground on pathways through which change will happen.