Who Will Lead on Maternal Mortality?

Back on Mother’s Day, New York Times columnist Nicholas Kristof weighed in from Somalia on maternal mortality in Africa. In other columns, he has brought needed attention to the issue of human trafficking, and his willingness to visit some rough corners of the world to comment on tragic realities indicates a commendable desire to protect vulnerable people from great suffering and injustice. Unfortunately, his concern is paired with profound wrongheadedness. 

He asserts that family planning is the way to save “many of the world’s 350,000 women who die in childbirth each year” – and laments that it is controversial at all. We pass legislation to provide contraception without conditions to wild horses, he notes, so why should humans be any different?

He acknowledges that the underlying conditions which lead to death in childbirth could be managed with basic medical competencies. But instead of giving this the attention it deserves, he moves directly to his “solution”: if Somali women had half the pregnancies, he actually comes right out and says, they would have half the maternal mortality. Imagining for a moment that Kristof’s solution were literally to come to pass overnight, this would affect the number of maternal mortalities but not the overall rate, presently 640 per 100,000 live births in Africa. It is only about 14 per 100,000 in developed countries.

Tell me how that is a “solution”?  Contraception does nothing to save the actual woman suffering from anemia or experiencing a complication around the time of delivery. Kristof makes clear, if unintentionally, that he views persons themselves as part of the problem to be solved: by eliminating or “preventing” people, we eliminate or reduce the problem. This of course can never be the product of a truly Christian worldview. But should it even rightly be called secular “humanism” – given that it downgrades the value of all human life and that, lacking any deference towards the transcendent, it ultimately involves the inhumane coercion of the weak by the powerful, not the kind of solidarity needed to address real problems of infrastructure and human development?

I still don’t have an iPhone, but if there were an “app” that could automatically provide readers with a much needed corrective to Kristof’s column, it would direct them to a recent article by Drs. George Mulcaire-Jones and Bob Scanlon in the Linacre Quarterly. This is a publication of the trustworthy Catholic Medical Association – not to be confused with the Catholic Health Association (which pushed for the passage of Obamacare).

“In the middle of the night”, they observe as Kristof does not, “a woman bleeding to death from a postpartum hemorrhage cannot be saved by a contraceptive device or a reproductive health mandate. An asphyxiated newborn cannot be resuscitated by the failed intent to prevent his or her conception.”

        The Magisterium of the Church has more to offer Africa than the New York Times.

 They note that the “reproductive health” model promoted by the United Nations over the last couple decades has yielded little improvement in Africa because the focus has not been on what causes “90 percent of maternal deaths,” but instead on the very thing Kristof recommends: “preventing women from becoming pregnant, rather than caring for women who are expecting a baby and the baby itself.” This derelict “strategy” has not only grossly failed to target the major causes of maternal mortality (such as hypertensive diseases, obstructed labor, and hemorrhage), but has “betrayed the basic premise of obstetrical care: obstetrics is the care of two persons: a mother and her fetus.”

These would seem to be elementary observations, and in a sane world greater investments would be directed towards what is actually known to save the lives of mothers and babies at their most vulnerable time (from the onset of labor until seven days postpartum): the presence of skilled birth attendants who can recognize complications and respond accordingly, antibiotics, safe blood banks, and certain agents that can prevent postpartum hemorrhage.  

They have developed and begun to implement their own “Safe Passages” program designed to do just these things. That such a proposal is seen by bureaucrats with the purse strings as marginal or threatening rather than indispensible is a sad commentary on the discipline of public health.

Both Mulcaire-Jones & Scanlon and Kristof begin their respective articles by sharing wrenching personal stories of mothers dying in labor. This of course is an effective means of engaging the reader; these stories should prompt a reaction. But their contrasting prescriptions make plain that only one is grounded in authentic compassion and medical integrity. Much as Kristof would have us believe otherwise, it is hardly compassionate to content oneself with halving the problem by halving the denominator. On the other hand, Mulcaire-Jones & Scanlon’s view of man and human development, explicitly informed by Catholic theology and Magisterial teaching, is why their approach to the issue is different, and far superior.

This is a prime example of what is at stake in the ongoing debates over Catholic identity in Catholic charitable agencies. Their sensible, desperately needed approach to maternal mortality is unlikely to attract public funding from Geneva or Washington D.C. But it is precisely the type of worthy initiative that private Catholic agencies should be keen on supporting.

Catholic agencies have the opportunity to provide leadership the UN has not. Sure, the Church can’t match what western donors spend on “reproductive health” programs, and no one pretends there aren’t huge practical challenges with even the best approaches. But the Church’s infrastructure in Africa is unrivaled. And the power of serene yet proactive moral witness should never be underestimated, as the life of John Paul II attests. Saying a needed “no” to collaboration on the U.N. agenda is one thing. Mulcaire-Jones & Scanlon provide us with the much-needed “yes.”

Matthew Hanley’s new book, Determining Death by Neurological Criteria: Current Practice and Ethics, is a joint publication of the National Catholic Bioethics Center and Catholic University of America Press.