On 30 December last year, the United Kingdom’s Department for International Development published its long awaited maternal health strategy ‘Choice for women: wanted pregnancies, safe births’. CMF was one of a number of Christian organisations involved in health and development issues that submitted comments to the consultation, making the point that multi level interventions were vital, and engagement with faith based organisations (FBOs) and faith communities was a neglected area of DFID’s work.
While the document shows that DFID recognises, at least in part, the role of political, cultural and religious factors in maternal mortality, and gives some recognition of the need to engage with FBOs and faith communities to address these, it does not really go into detail about how it means to do this, and to my mind it seems to be a tokenistic recognition rather than a full and proper engagement. As ever, the reality will be worked out on the ground in each country.
The deeper cultural and social issues such as the status of women, the role of religious and wider cultural values in shaping this status and attitudes to childbirth, plus the issues of poverty, social inequality and the exploitation of the poor in general and women in particular are all well addressed. However, the grim reality of sexual exploitation, including trafficking of women and girls is largely overlooked.
There is also a somewhat sinister emphasis on the need to control population in developing countries. While the huge upswing in teenagers and younger school children does present challenges, it also creates huge opportunities for developing nations to invest in a dynamic upcoming generation. Family size tends to ‘self limit’ in most societies with a rise in education and living standards. But the emphasis on reducing the population of the poor, especially to reduce global warming is off kilter (eg the poor contribute next to zero to total carbon emissions). If we are to lift them out of poverty, there is an issue to do with the rising environmental and food production impact of an increasingly affluent third world middle class. But to lay that burden on the poorest by pressurising people to limit family size, when they still expect to lose a number of their children in early life, seems profoundly unjust (and not a little paternalistic) at best.
The bigger issue is the type of lifestyle we are exporting to the developing world as people are lifted out of poverty (raising even more profound questions about our own lifestyles here in the West), and the need to think more creatively in terms of food production, low carbon technologies, and simpler models of living within the planet’s resources. We tend to export our problems to the poor, foisting upon them troubles not of their own making.
In summary, the poor have large families to ensure some of them survive to adulthood. Lower child mortality, better education and higher standards of living will lead to reduced family size within a generation or two, provided there is appropriate access to family planning and good antenatal and postnatal care.
Reducing the number of unintended pregnancies does, however, have an impact on the number of terminated pregnancies, and we wholeheartedly support DFID’s aim of reducing the number of abortions. However, digging into the detail again, there seems to be a double standard here. One moment DFID acknowledges that all abortions have health sequelae for the women, while the next it is promoting ‘safe’ abortion (not mentioning the fact that this still has health consequences for the woman). Furthermore, it soon becomes apparent the main emphasis in the strategy seems to be that preventing the need for abortion is a cost saving compared to providing an abortion, with the added costs of coping with the physical and mental health problems for the woman afterwards! That a child dies in this process is not even acknowledged.
Furthermore, DFID places a strong emphasis on working with the United Nations Population Fund – UNFPA (with its pro-abortion and population control stance) and the World Bank (with its poor value for money track record and tendency to be dismissive of faith-based responses). While working with international bodies is necessary and valid, these two have a dismal track record, and we would be very sad to see DFID work too closely with them without challenging their more questionable policies and practices.
So, while we celebrate much that is good in this strategy, and sincerely hope that it goes some way towards helping to reduce the death toll and health problems facing mothers in the developing world, there is also much that we question, and we will need to keep a close watch in the long term to see how this works out in practice. Fine words do not save lives.