By Kevin Watkins, director of the Education for All Global Monitoring Report
There are few starker indicators of global inequality than maternal mortality. Risks of death from causes associated with pregnancy in childbirth are heavily concentrated in developing countries – over 80% of fatalities happen in South Asia and sub-Saharan Africa. The world’s most dangerous place to give birth is Niger, where women face a 1 in 7 chance of fatality. The odds in rich countries average 1 in 8000.
Maternal survival has long been viewed as a “no progress” zone in international development. That assessment may be about to change. Evidence published on Monday in The Lancet and reported on Tuesday in The New York Times suggests that maternal mortality rates may be declining. Improved ante-natal and obstetric care and better nutrition have all played a role. But the Lancet research also highlights the key role of maternal education in saving lives, pointing in particular to the fact that average years of schooling for women aged 25-44 in sub-Saharan Africa increased from 1.5 in 1980 to 4.4 in 2008.
What are the transmission mechanisms from education to survival? As we argued in the 2010 Global Monitoring Report and in a posting earlier this week, maternal education has the twin effect of improving access to information and empowering women to make choices.
All of this has crucial implications for the international development goals. Maternal health and child survival are set to dominate the development agenda for the Group of 8 summit in Canada in June and the Millennium Development Goals summit planned for September. The focus has been on strengthening what public health analysts describe as “the continuum of care” for pregnant women and children – a chain stretching from nutrition to providing ante-natal care, skilled birth attendants, obstetric and post-partum care, HIV/AIDS counselling and reproductive health support. There is no substitute for care in these areas. By the same token, there is no substitute for education in giving women the independence, autonomy and tools they need to make use of that care.
There are plenty of good reasons for putting women and children at the top of the international development agenda. A narrow focus on public health, however, could diminish the impact of international action. We shouldn’t let the Millennium Development Goals framework force choices between health, education and other sectors. Young girls and women do not need health or education – they need both.