[Congressional Record (Bound Edition), Volume 154 (2008), Part 7]
[Extensions of Remarks]
[Pages 9164-9165]
[From the U.S. Government Publishing Office, www.gpo.gov]




SUPPORTING FUNDING TO REDUCE THE MATERNAL MORTALITY RATE THROUGHOUT THE 
                                 WORLD

                                 ______
                                 

                       HON. JANICE D. SCHAKOWSKY

                              of illinois

                    in the house of representatives

                        Wednesday, May 14, 2008

  Ms. SCHAKOWSKY. Madam Speaker, every minute a woman somewhere in the 
world dies of pregnancy-related causes. This staggering fact is not a 
failure of science but rather a failure of conscience. The United 
States possesses the medical knowledge necessary to drastically reduce 
the number of women killed during pregnancy each year. What we lack is 
a commitment by our Government to make certain that medical resources 
are readily available to women throughout the world.
  The United States can and most do more. To demonstrate just how 
attainable this goal is, I would like to bring my colleagues' attention 
to an interesting and inspiring piece published in The Washington Post 
on Sunday, May 11, that highlights the efforts of two remarkable 
individuals to address maternal mortality rates in Haiti. Working 
closely with the Haitian government, Paul Farmer, Ophelia Dahl, and 
their nonprofit organization Partners in Health, have succeeded in 
reducing the maternal mortality rate in Haiti to less than half what it 
was a quarter-century ago. I hope that this piece will not only serve 
as a reminder of the tremendous opportunity we have to save the lives 
of hundreds of thousands of pregnant women all over the world.

  Keeping New Mothers Alive--In Haiti and Rwanda, Reducing Tragedy in 
                               Childbirth

                   (By Paul Farmer and Ophelia Dahl)

       ``Obscene'' is still the word that comes to mind when we 
     think of maternal mortality--and it has been almost 25 years 
     since we first witnessed death in childbirth. In 1983, as 
     students in one of central Haiti's fetid clinics, we prepared 
     to celebrate a birth. Although we'd just met the young woman 
     about to become a mother, her desperate expression as she 
     began to hemorrhage haunts us still. National statistics 
     could have predicted the outcome: A 1985 survey pegged 
     Haitian maternal mortality at 1,400 deaths per 100,000 live 
     births. By comparison, maternal mortality in the United 
     States last year was 14 deaths per 100,000 live births.
       Worldwide, 500,000 women die in childbirth every year; more 
     than 90 percent live in Africa or Asia, and almost all are 
     poor by any standard. Obscene though it is, death during 
     childbirth isn't the end of the story. In the world's poorest 
     areas, many orphaned children wind up destitute and on the 
     streets within a few years of their mothers' deaths, 
     sometimes resorting to desperate or criminal measures for 
     food, shelter, clothes or school fees.
       One of the 12 Millennium Development Goals is to reduce 
     maternal mortality 75 percent by the year 2015. But we are 
     moving too slowly to meet this goal, the United Nations says.
       Today, the maternal mortality rate in Haiti is less than 
     half what it was a quarter-century ago. Across the broad 
     swath of central Haiti where we work, we estimate the number 
     to be well below 100 deaths per 100,000 live births--not good 
     enough but a vast improvement, most of it occurring in the 
     past decade. Change came largely for three reasons.
       First, our nonprofit organization, Partners in Health, has 
     worked closely with the Haitian Ministry of Health to 
     strengthen public health infrastructure. We have rebuilt, 
     equipped, staffed and stocked hospitals and clinics; trained 
     nurse-midwives and other personnel, including more than a 
     thousand community health workers; linked villages and health 
     centers to district hospitals by modern telecommunications 
     and ambulance service; and established modern surgical 
     services for obstetrical emergencies.
       Second, we have broken the rule that high-quality health 
     services are a privilege rationed by ability to pay, not a 
     right. The case was made first for affordable medicines. Now 
     it is being made for emergency Caesarean sections--an 
     essential tool to reduce maternal mortality. Faced with 
     evidence that maternal mortality was greater where fees were 
     higher, the district health commissioner for central Haiti 
     announced last August that all prenatal care and emergency 
     obstetrical services would henceforth be available free to 
     all patients. He was later echoed by Haitian President Rene 
     Preval.
       Third, we have linked prenatal and obstetric care to an 
     all-out effort to improve access to primary health care. The 
     presence of functional, accessible public clinics and 
     hospitals restores faith in the health system, motivates 
     people to seek care before they are critically ill and allows 
     for preventive interventions such as prenatal care and family 
     planning. Consider Rwanda, another country

[[Page 9165]]

     where we work, which is rising rapidly from its ashes 
     scarcely a dozen years after an appalling genocide. Rwandan 
     maternal mortality rates in 1995, the year after the 
     genocide, are unknown. But they are sure to have exceeded the 
     1,800 deaths per 100,000 live births reported that year in 
     relatively peaceful Malawi. The situation has improved 
     dramatically since then.
       By helping to train and, importantly, pay community health 
     workers, the Rwandan Ministry of Health is taking steps to 
     link rural villages to health centers with the capacity to 
     make routine labor safe. Rwanda is also seeking to make 
     family planning available to citizens and to increase access 
     to preventive and primary care through basic health 
     insurance. Maternal mortality has dropped from more than 
     1,000 deaths per 100,000 live births between 1995 and 2000 to 
     less than 600 today--still terrible but well below the 
     average (940) reported for sub-Saharan Africa.
       At the government's invitation, Partners in Health launched 
     efforts to strengthen AIDS treatment and primary health 
     services in one region of rural Rwanda in 2005. Mindful of 
     the lessons learned during two decades of work in rural 
     Haiti--and of that young Haitian woman whom we watched turn 
     abruptly from the anticipation of new life to a confrontation 
     with death--we have made reducing maternal mortality and 
     improving women's health top priorities. And we have welcomed 
     the opportunity to support Rwanda's commitment to breaking 
     the cycle of poverty and disease by including health care and 
     education (especially for girls) in its vision of the future. 
     It's probably no coincidence that Rwanda also boasts the 
     world's highest percentage of women in parliament.

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