[Congressional Record Volume 152, Number 135 (Friday, December 8, 2006)]
[Senate]
[Pages S11683-S11684]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           MATERNAL MORTALITY

  Mr. DURBIN. Mr. President, I rise today to talk about what should be 
a moment of great joy: the birth of a child. But for millions of women 
in the world, childbirth is a deadly game of Russian roulette.
  Over 500,000 women died last year in childbirth or from complications 
during pregnancy. Another 10 million were injured or disabled, often 
permanently. During her lifetime, a woman in Angola has a 1 in 7 chance 
of dying in childbirth or from complications stemming from pregnancy--1 
in 7. In Sierra Leone, the risk of dying is 1 in 6. That number is the 
same in Afghanistan--a 1 in 6 chance of dying from pregnancy or 
childbirth. In developed countries, such as ours, the risk of dying in 
childbirth is 1 in 2,800. Every such death is a tragedy, but it is hard 
for us to even imagine that we would lose 1 of every 6 or 7 of our 
mothers, wives, sisters, or daughters.
  That statistic, the chance of dying from childbirth, represents one 
of the widest chasms separating rich and poor countries.
  That gap is wider than differences for life expectancy and wider than 
differences in child mortality, even though the health of the mother 
and her baby are deeply intertwined.
  As Isobel Coleman of the Council on Foreign Relations has stated, 
``In some countries, getting pregnant is the most dangerous thing a 
woman can do.'' We have an obligation to change that state of affairs.
  Earlier this fall, William Kristof wrote in the New York Times, 
``These women die because they are poor and female and rural--the most 
overlooked and disposable people throughout the developing world.''

[[Page S11684]]

  Kristof did a pair of columns on the subject of maternal mortality.
  In the first column, he described how a young woman in Cameroon named 
Prudence Lemokouno was desperately ill. Her baby was already dead and 
she was dying, her uterus ruptured. After 3 days of labor, her family 
had managed to get her to a hospital, but the doctor initially refused 
to operate, saying he needed both money and blood. The family did not 
have the money, and the nearest blood bank was 50 miles away. Kristof 
and his associate provided the money and donated the blood. They hoped 
it would be enough, but the doctor still did not operate immediately. 
Later, Mr. Kristof wrote a second column. In it, he told us that the 
young woman had died. In describing her struggle, he wrote, ``It was 
obvious that what was killing her wasn't so much complications in 
pregnancy as the casual disregard for women like her across much of the 
developing world. . . . It's not biology that kills them so much as 
neglect.''
  We cannot continue to overlook these women. No one should be 
disposable. And today's devastating statistics do not have to be 
tomorrow's realities. We cannot make childbirth risk free; it is not. 
There are sometimes factors and conditions that doctors cannot in the 
finest hospitals in the world cannot prevent.
  But women and girls in developing countries die at such tragically 
high rates during pregnancy and childbirth primarily for some basic and 
preventable reasons. And many of the solutions are both simple and cost 
effective.
  Millions of deliveries in the world take place without a skilled 
birth attendant--that means no doctor, no nurse, no midwife, no one 
with any medical training at all. In fact, millions of women literally 
give birth alone.
  The shortage of health workers handicaps the world's fight against 
HIV/AIDS and every other global health challenge. That is equally true 
of the struggle against maternal mortality. Training community health 
workers, nurses, midwives, and doctors is part of the battle. But it is 
also critical to help countries better distribute their health 
workforces and better manage their health systems.
  Malawi, for example, has one of the highest maternal mortality rates 
in the world. But 25 percent of its nurses and 50 percent of its 
physicians are concentrated in 4 central hospitals. And yet the 
population of Malawi is estimated to be 87 percent rural.
  We address the maternal mortality crisis in part by building health 
workforces to provide prenatal care and to be there during delivery, in 
rural areas as well as cities.
  We also help countries address this crisis by getting them to take a 
second look at child marriage. In developing countries, girls aged 10 
to 14 who become pregnant are 5 times more likely to die in pregnancy 
or childbirth than women aged 20 to 24. These same young mothers are 
also at higher risk of obstetric fistula. Fistula is a devastating 
condition that can result from prolonged labor without medical help. In 
the end, as a result, babies are most often stillborn and women and 
girls are left with gaping holes in their bodies that leak feces and 
urine. They are then often abandoned by their families.
  Even if their mothers escaped this brutal, prolonged labor and its 
terrible consequences, infant mortality rates for the babies of these 
child mothers are also much higher than for the children of older 
women. Yet an estimated 25,000 girls are married each day in the world, 
some of them as young as 7 or 8 years old.
  We save lives not by demanding that countries ban child marriage in 
fact, child marriage is officially illegal in most nations. We save 
lives by convincing communities to keep their daughters in school 
rather than marrying them off. Many parents believe that marrying their 
daughters early is the best way to keep them safe from sexual predators 
and other dangers. We can help their communities find better ways to 
keep their daughters safe.
  Senator Hagel and I have introduced a bill, the International Child 
Marriage Prevention and Assistance Act, to help countries take such 
steps. We plan to reintroduce this bill when Congress reconvenes for 
the new session in January and work toward its enactment.
  Women and girls also die during pregnancy and childbirth because they 
are cut off from access to health care. There is a direct link between 
lack of transportation and high maternal mortality rates. That is one 
of the many links between poverty and maternal mortality. Being poor 
should not be a death sentence.
  Rural development is critical to solving this problem, and reducing 
maternal mortality will enhance economic development. We can and should 
train more health workers, encourage communities to end child marriage, 
and build better transportation networks.
  But those aren't the only factors that affect maternal mortality and 
our response to it. Politics is another cause of death. Of all the 
factors that contribute to the deaths of mothers, and often their 
babies, this is the easiest one to fix and the most unforgivable to 
allow to persist.
  The United Nations Population Fund, UNFPA, is an organization that is 
doing lifesaving work. They help to promote reproductive health, 
including, for example, providing safe delivery kits. What is a safe 
delivery kit? It is often just a plastic sheet, a bar of soap, a razor 
to cut the umbilical cord, and a string to tie it. Imagine being on the 
verge of giving birth or knowing that your wife is about to deliver and 
lacking even these most basic supplies.
  UNFPA provides family planning assistance in countries where they are 
welcomed. In those countries, they provide this help to families who 
ask for it. They also have a well developed program to prevent and 
treat obstetric fistula, that terrible condition which I described 
earlier that results from prolonged labor without medical assistance.
  So each year, Congress appropriates money to support UNFPA's efforts 
to help countries and families who want their assistance. Yet every 
year the Bush administration has withheld that money. The 
administration does so because it claims that since UNFPA works in 
China, that UNFPA is supporting or participating in coercive abortions 
or involuntary sterilization, practices which the Chinese Government 
has long carried out.
  In fact, UNFPA works to do exactly the opposite. UNFPA promotes 
voluntary family planning and opposes abortion as a form of family 
planning.
  The United States sent a fact finding mission to China in 2002 to 
investigate this matter. It found no evidence of wrongdoing by UNFPA 
and recommended that the funds Congress appropriated for UNFPA be 
released. Studies have shown that abortions decrease in areas where 
UNFPA operates--and so do maternal and child mortality.
  False accusations that UNFPA supports abortions in China are cutting 
off funding that could help save the lives. Yet, on September 13, for 
the fifth year in a row, the Bush administration announced that it was 
withholding the $34 million appropriated by Congress for UNFPA.
  Every minute, a woman in the developing world dies from treatable 
complications of pregnancy or childbirth. That is a terrible tragedy. 
But the fact that politics are making this tragedy worse is an 
abomination.

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