Dying for change

It was Mothers' Day yesterday, and in those 24 hours about 1,500 women will have died giving birth, as they do every day of the year. Almost all the deaths will have been in the world's 75 poorest countries. Most would have been preventable in more affluent nations. Maternal health is a bald and unforgiving indicator of the state of a country's medical services - and its civil society. After all, most women give birth. A society that neglects their needs is a society that institutionally discriminates against women.

In a report released on Mothers' Day, MPs on the international development select committee have established that the true number of deaths might be 50% higher than the official estimates: perhaps as many as 870,000 women die annually in the days around birth. For every death, another 30 women are reckoned to be left in some way disabled. In sub-Saharan Africa things are actually getting worse.

In development circles there is agreement about what needs to be done. Governments need to make it happen. Slender budgets - and not just in health - fail to reflect women's needs. In Bangladesh, educating girls has been the key to reducing maternal deaths. Educated young women are more likely to seek antenatal care, and more likely to give birth in clinics.

Rural sub-Saharan Africa presents particular problems. The worldwide shortage of midwives is at its most acute, and scarce clinics are poorly equipped. Most women give birth without skilled assistance, so complications are often detected too late for women to reach distant medical help. Governments must reward staff for working in those backwaters where they are currently reluctant to locate. In Katine, Uganda, where the Guardian is a co-sponsor in a three-year project, the skills of traditional birth attendants are being upgraded, while staff are being recruited and trained to work in rural clinics. New ways must also be found to help women travel in the event of emergency. In Malawi a scheme has been set up where police transport can be called in.

Safe birth is only part of the equation. More than one in 10 maternal deaths is linked to unsafe abortion. Improving access to abortion, and above all to contraception, could, the MPs point out, save thousands of women a year. But the most powerful tool right now is advocacy. The White Ribbon Alliance campaign for improved facilities aims to force governments to reconsider their priorities. The rate of maternal death will not fall by the 75% demanded by the millennium development goal without a transformation in attitudes. Less progress has been made here than in any of the other goals for 2015 set by the UN. That is not a reason for giving up. It is a reason for shouting louder.