Maternal mortality: a children's rights issue?

I was flicking through a copy of the New Internationalist when I came across a 'country profile' of Sierra Leone.  Amnesty's Demand Dignity campaign is active on the issue of maternal mortality in the west African country, home to 5.6 million people – and the second worst statistic on motherhood in the world.  (Read the full Demand Dignity report here.)

To summarise: In Sierra Leone, 1 in 8 women die during childbirth.  That's 155 women per 1,000 live births.  To give a sense of comparison, neighbouring Guinea is at 93 deaths per 1,000 live births.  In the UK it is 5 per 1,000 – or 1 in 8,500 women die during childbirth.  Whatever way we crunch the numbers, it is clear that, as Amnesty has rightly pointed out, this is a maternal rights emergency.  And not only that – HIV is at 1.5% for women in Sierra Leone, rising to 4.4% in pregnant women.

Initially it is not all that clear why this is a children's rights issue.  It is very clear that it is a women's rights issue – women enduring on of their most important medical moments of their lives are clearly being neglected; often dying from preventable complications. 

Another statistic jumped out at me, however: 94% of Sierra Leone's femalepopulation have been circumcised; subject to a practice commonlycalled female genital mutilation (FGM). This is also common practice in Burkina Faso, another of Amnesty's key maternal mortality campaign countries.

The World Health Organisation (WHO) says that: “deliveries to women who have undergone FGM are significantly more likely to be complicated by caesarean section, postpartum haemorrhage, episiotomy, extended maternal hospital stay, resuscitation of the infant, and inpatient perinatal death, than deliveries to women who have not had FGM.”

In the Sierra Leone report, Mahmoud Marah, who's young wife died giving birth, says 'It is because of poverty that these things are happening'.  His child, for whom his wife made the ultimate sacrifice, died at only 40 days old.  This tragedy is an all-too-common occurence in Sierra Leone, and certainly poverty is an overwhelming cause – but not without the provision of  'access to education as well as reproductive health information and services'.  Yet again, the keystone to change is education.  And education about FGM is key.

In Copenhagen in November 2009, the conference for Amnesty's global children's rights movement were privileged enough to hear the story of Kakenya, an extraordinary woman who campaigns for the education rights – and has set up an academy for girls in Kenya.  Her story was an inspiration – myriad details have stayed with me.  So compelling that I will repeat the first part here (you can read more of her story on the website for her school):

"My life was set to follow the traditional path of all girls born inthe small Maasai village of Enoosaen, Kenya where I grew up. Engaged atthe age of 5, I was to be circumcised by the time I became ateenager—an event that would mark the end of my education and thebeginning of my preparations for marriage.

"But I had a different plan. First, I negotiated with my father: Iwould willingly agree to be circumcised only if he would allow me tofinish high school. He agreed. Then I negotiated with the villageelders to do what no girl had ever done before: leave my village insouth Kenya to go to college in the United States. I promised that Iwould use my education to benefit Enoosaen and the entire villagecollected money to pay for my journey."

It is interesting how she frames the circumcising as the event that would 'mark the end of my education and the beginning of my preparations for marriage'.  Although this is Kenya and not Sierra Leone, these young girls are still subject to the same traditional pressures, to be 'cut', often in a ceremony involving the the whole village.  Kakenya also told us that she was 'not allowed to cry'.  Her bravery in brokering a deal with her father and the elders shows her canny attitude towards her future – and her desire for a decent education.

Maternal mortality is clearly linked to the practice of FGM.  Kakenya described how many women in her village did not have the education to make this link.  I am no doctor myself, but it is now clear to me that a high HIV rate in pregnant women, a high FGM rate, and a high maternal mortality rate are implicitly linked, across many countries where the practice exists.

Read the factsheet about FGM on the WHO's website: It is mostly carried out on young girls sometime between infancy and age 15 years.  An estimated 100 to 140 million girls and women worldwide are currently living with the consequences of FGM.  

Let us not ignore the WHO's findings.  The path to death during childbirth may begin when the future mother is still a child herself.

In Sierra Leone in 2007, a Child Rights Act was passed banning FGM completely.  In Burkina Faso a similar law was passed back in 1996.  But as we know, many traditional practices will continue unabated, regardless of law. The anguish caused by FGM isn't just medical – Kakenya even mentioned that many men prefer an 'uncircumcised' wife – meaning the practice is both deeply embedded in tradition and yet falling out of favour with many potential husbands.

That is where we come in, as children's rights activists.  That is where people like Kakenya come in, as as a passionate educator of young girls. FGM is a children's rights issue.  And maternal mortality is an FGM issue.

Take action with Amnesty on maternal mortality here.  In your letters, be sure to indicate that stronger monitoring of FGM and the health rights of young girls should be undertaken by governments and NGOs working on reducing maternal mortality in Africa.

Donate to Kakenya's school here.

Thanks for reading.  

Helle :)