In the past decade, billions of dollars have been spent trying to save the lives of mothers in developing countries using strategies — usually inexpensive drugs — deemed essential by the UN health agency.
Yet two large analyses of maternal health programs — including one conducted by the UN itself — report that the efforts appeared almost useless, raising troubling questions about why all that money was spent.
While critics are calling for the pricey global initiatives to be significantly overhauled, the programs are still being implemented despite little proof they work. The practices mainly involve things like ensuring women giving birth get cheap drugs such as magnesium sulfate to treat labor complications or pre-emptive antibiotics for those getting a Caesarean section.
Even public health officials acknowledge they were taken aback by the studies.
“Nobody could have been more surprised than I was when we got the results,” said Omrana Pasha of Aga Khan University in Pakistan, who led a study of maternal health interventions in six countries in Latin America, Africa and Asia.
“In clinical medicine, we would not prescribe a drug unless multiple trials show that it works,” she said. “The FDA [Food and Drug Administration] won’t allow a drug to be marketed without that evidence. But things are different in public health.”
At an international meeting of UN partners that started yesterday in South Africa, health officials are getting ready to ask donors for even more money to pour into maternal health programs. Since 2009, the US has invested more than US$13 billion in maternal and child survival, hoping to save lives by supporting “high-impact” health interventions.
According to the research papers, including one done in 30 countries that tracked more than 300,000 women, scientists found no link between the supposedly lifesaving interventions and the death rates of women giving birth. Areas that used the interventions did not have better survival rates for mothers than areas that did not.
The two papers published last year are the biggest to assess the effectiveness of maternal health strategies, although smaller studies have previously suggested the methods help. But they gained little traction, perhaps because there does not appear to be an easy fix.
Experts, meanwhile, are largely stumped as to why their methods failed to prevent deaths.
“We assume that if women get these things, they will be saved. But it’s too simple to say one plus one equals two,” said Marleen Temmerman, director of the WHO’s maternal health department.
She is not convinced the interventions do not work. She suspects there were problems implementing the strategies.
“Maybe the health facility has the medicine, but the man who has the key to the cupboard is gone,” she said.
Temmerman also said it would be dangerous if donors abruptly slashed their support for maternal health initiatives.
Some experts said existing plans should be adjusted.
“These essential interventions are important, but they are not enough,” said Sandrine Simon, a public health adviser at Doctors of the World charity. “This is about more than buying the right medicines.”
Others said major changes were required to save more women.
“We need to be more honest and serious about past failures otherwise we will keep making the same mistakes,” said Bill Easterly, an economist at New York University. “It’s not just the fault of countries receiving aid who aren’t implementing the technology properly, it’s the fault of Western aid agencies and donors who are not trying hard enough to get it right.”
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