Guest blog by Rebecca Tiessen, University of Ottawa, May 22, 2014
Maternal health should be about women’s health before, during and after pregnancy, not just mothers. Some women who require maternal healthcare will not become mothers because fetuses and babies may not survive or because the women may not choose to raise these children. Therefore, an effective and comprehensive maternal health strategy is key. It should include services that address women’s maternal health needs, while also addressing the broader societal and gender issues which contribute to high rates of maternal mortality.
The Muskoka Initiative on Maternal, Newborn and Child Health (MNCH), however, focuses almost entirely on mothers. We can witness this in Canada’s official statements on the MNCH initiative. For example, in a September 25, 2013 speech, Prime Minister Stephen Harper referred exclusively to mothers when referring to the MNCH, saying: “one of the world’s great tragedies […] is the shocking mortality of mothers and their young children in developing countries”.
The emphasis on mothers is significant here, however, because it is actually women who die. Some of them never become mothers before their death. Other women may die months following a pregnancy as a result of complications, infections and unsafe abortions.
The World Health Organization estimates that, for every woman who dies in childbirth, around 20 more suffer injury, infection or disease related to their pregnancies, affecting approximately 10 million women each year. Thus, the exclusive focus on mothers reduces women to a specific biological activity: giving birth. The focus on mothers rather than women in the maternal health strategy treats women as “walking wombs” and makes it far more difficult to address the broader health challenges women face in their lives.
Responding to these broader maternal health challenges require a better understanding of gender inequality, including gender-related issues such as lack of access to resources, lack of permission from men in the communities to use household funds for maternal healthcare, and gendered institutional practices that result in women having negative experiences in health clinics. As such, maternal health programs cannot be isolated from broader gendered, societal and community issues that women face in accessing healthcare services.
The MNCH initiative’s failure to more explicitly link maternal health needs to women’s disadvantaged position in society relative to men further solidifies Canada’s shift away from a gender-and-development approach to a charity-based model. It fails to address the gendered societal norms that prevent women from accessing health services even when they are available. As a result, the MNCH initiative has limited potential for improving the quality of life for women who still have little or no say over sexual and reproductive rights and child spacing.
A focus on the promotion of gender equality in maternal health programs has the potential to correct for this shortcoming. Such a strategy would include education programs and involving women in the design and implementation of maternal health strategies. However, a gender-sensitive approach to maternal health in Canada’s MNCH initiative is unlikely, as illustrated by the problematic language of “saving” mothers and children.
“Saving” mothers and children through maternal health programs is a common theme throughout many of the official Canadian statements pertaining to the MNCH initiative. The announcement of the May 2014 summit titled Saving Every Woman Every Child: Within Arm’s Reach is further evidence of Canada’s charitable approach to maternal health and a narrative that stresses Canada’s role in saving the “vulnerable other”. In so doing, women are further positioned as objects of development assistance (recipients of charity), as opposed to subjects with agency that are capable of being actively involved in the development process.
For four years, Canada has made MNCH a key priority in foreign aid spending. This initiative, however, has been severely limited by its exclusive focus on “mothers”, the failure to put women and gender equality at the centre of these initiatives, and the ongoing paternalistic references to strategies aimed at “saving” vulnerable groups. If the upcoming summit provides a space to reflect meaningfully on what has been achieved through the MNCH initiative to date, it will most certainly need to begin with some reflection on these and other important weaknesses of Canada’s Muskoka Initiative. A renewed commitment to maternal health is welcomed, but achieving success in maternal health services will require a new direction and purpose: one that begins with an understanding of the causes and consequences of gender inequality.
For additional information see: Krystel Carrier and Rebecca Tiessen, “Women and Children First: Maternal Health and the Silence of Gender in Canadian Foreign Policy” in Canada in the World: Perspectives on Canadian Foreign Policy, edited by Heather A. Smith and Claire Turenne Sjolander, Oxford University Press, 2012, pp. 183-200.