A slew of news articles this week have focused on two recent reports about the number of women who die during pregnancy or in childbirth around the world every year.
The reports don’t exactly agree, and with public health experts and heads of state meeting at the United Nations this week to discuss maternal and child health issues, it is no surprise that some squabbling over the data has emerged. Unfortunately, reporters have not provided much detail or clarity about either the squabbling or the data.
On Wednesday, The New York Times gave its lead front-page slot to a study published in the medical journal The Lancet, where, “For the first time in decades, researchers are reporting a significant drop worldwide in the number women dying each year from pregnancy and childbirth, to about 342,900 in 2008 from 526,300 in 1980 … The study cited a number of reasons for the improvement: lower pregnancy rates in some countries; higher income, which improves nutrition and access to health care; more education for women; and the increasing availability of “skilled attendants” — people with some medical training — to help women give birth.”
So far, so good, but the Times’s Denise Grady, who wrote the article, quickly flipped the focus of her piece by adding that “some advocates for women’s health tried to pressure The Lancet into delaying publication of the new findings, fearing that good news would detract from the urgency of their cause, [the journal’s editor] Dr. [Richard] Horton said in a telephone interview.”
Horton also disclosed (and rightly criticized) the requests to hold off from publishing in a long comment piece attached to the research article in The Lancet—but neither there nor in the Times does he say exactly where (or who) the pressure came from. That is his decision, and probably a wise one. What is frustrating, however, is that Grady chose to emphasize this angle in the top of her story, but found nobody to substantiate the impression that it is a significant issue.
In fact, most articles took a pass on Horton’s comments about pressure from advocacy groups. One exception was the Associated Press, which mentioned it right in the lede (although, curiously, a headline on an early version of the story that read “Politics of aid seen in clash over maternal deaths” was later changed to “Lancet: Sharp drop in maternal deaths worldwide”).
Unfortunately, the AP had nothing to add on the extent to which advocates are actually concerned about the political (read: financial support) ramifications of the statistics presented in The Lancet. What the article, by Maria Cheng, does mention is that “A separate report by a group headed by the United Nations reached a very different conclusion on maternal mortality, saying the figure remains steady at about 500,000 deaths a year.”
The problem is “a group headed by the United Nations” did not produce that report. Farther down in her article, Cheng reports that it came from the Partnership for Maternal, Newborn and Child Health, a global alliance hosted by the U.N. World Health Organization. In fact, it came from an advocacy group called Countdown to 2015, which does not appear, from its Web site, to be affiliated with the U.N. Furthermore, the AP’s assertion that the group found that maternal mortality has “remained steady” at half a million deaths per year seems suspect. After making that statement in the second paragraph, Cheng eventually goes on to specify that 350,000 to 500,000 women still die in childbirth every year. (And that is an improvement on the same paragraph in the earlier version of the article, which used the weaker specification, “up to 500,000.”)
Cheng’s confusion seems to stem from a press release about the Countdown to 2015 analysis released by the Partnership for Maternal, Newborn and Child Health. It is ironic that she should mistakenly use that group, in particular, as the supposed foil for the maternal mortality statistics published in The Lancet. In The New York Times article, Grady quotes its director, Dr. Flavia Bustreo, saying that the statistics represented “hope at last,” and that her organization was not one of those that tried to delay release of the findings.

The most important point is that, even with the lower estimates, the progress in 30 years was only a 35% decrease, and the MDG target is 75%. Still a lot of ground to be covered within only 5 years! Especially when the Lancet article also point out that only 21 countries are on track to achieve a 75% decrease in MMR by 2015.
#1 Posted by Carmen Barroso, CJR on Thu 15 Apr 2010 at 04:35 PM
The Lancet Report is actually VERY GOOD news for advocates of action on maternal mortality, as it shows that progress is indeed possible. There are lessons learned and strengths that can be built upon. The issue has appeared intractable to policy makers - yet imminently solvable to those working on the ground. Indications of progress should always be seized as opportunities to break up the resignation and hopelessness that so many lawmakers have about global health issues, and spur them to action.
#2 Posted by John Coonrod, CJR on Fri 16 Apr 2010 at 08:45 AM
Hi Curtis! Thanks so much for such a thoughtful analysis of the coverage of this story. I work at the Maternal Health Task Force at EngenderHealth and I have been compiling and posting on our blog reactions to the new mmr estimates from various leaders in maternal health. You might find these insider reactions to the estimates quite interesting. http://maternalhealthtaskforce.org/index.php?option=com_wpmu&blog_id=1&p=1458&Itemid=115
Thanks for such a great post! I shared it on the MHTF Blog as well as my personal blog, maternalmortalitydaily.wordpress.com
Take care!
Kate Mitchell
#3 Posted by Kate Mitchell, CJR on Thu 22 Apr 2010 at 04:47 PM