Maternal mortality in Honduras and Peru: Meeting the Millennium Development goal target of 2015

The Safe Motherhood Initiative launched in Nairobi, Kenya in 1987and the World Summit for the Rights of the Child in New York in 1990 drew international attention to the importance of improving maternal health. Scant progress has been made towards reaching the Millennium Development Goal of a three-quarter reduction in maternal mortality by 2015. The death of a pregnant woman- widely regarded as a rare and avoidable tragedy in most developed countries, becomes a fairly frequent, almost invisible, event in most developing countries. Unacceptably large numbers of women still die or suffer life-threatening trauma from preventable obstetric causes. Improvements in maternal health are hindered in part by a lack of consensus regarding how maternal mortality is defined and documented. In addition, development assistance is more likely ear-marked for Infectious Disease based programs compared to infrastructure development based programs and very low priority is given to reproductive health care.

With similar demographic, socioeconomic and health infrastructure, Honduras and Peru not only provide an opportunity for insightful comparison of maternal mortality trends over the past two decades, but also help shed light on some key players involved in them. According to WHO World Health Statistics, the maternal mortality ratio in Honduras is 110 per 100,000 live births compared to 410 in Peru. Between 1990 and 1997 Honduras reduced the number of deaths due to complications of pregnancy and childbirth by 40%, one of the largest reductions ever made in a developing country in less than a decade. Peru, on the other hand, a country with a higher Human Development Index, continues to wrestle with a maternal mortality ratio that is nearly four times as high. Why does the path to improved health care for women differ in these two nations? What lessons can be learned that might provide insights into programming and health care system development in other countries and regions? With similar levels of poverty, literacy, life expectancy, and births attended by skilled personnel, the discrepancy in maternal mortality between these two countries is particularly compelling.

As maternal mortality throughout the developing world remains stubbornly resistant to improvement, the remarkable, short-term advance in Honduras holds out hope for the possibility of significant progress before the Millennium Development Goal target of 2015. At the end of this comparative analysis, we see political prioritization of funding towards infrastructure, accurate census data, sustained commitment to accessible primary health care, and accountability in health systems development to be chief role players.