Richard Horton, editor-in-chief of The Lancet medical journal, released a ten-point framework for the document on Twitter in the final hours of the conference. He began with an appeal for “a new and challenging goal for maternal mortality post-2015, led and defined by countries, not donors” and which “depends on universal health coverage: a strong health system offering family planning, [emergency obstetric care, and] safe abortion.”
Horton was among the plenary speakers at the three-day Global Maternal Health Conference held in the remote town of Arusha, Tanzania, which was sponsored by the Gates and MacArthur Foundations, UNICEF, and UNFPA. Such conferences are deliberately held in remote locations to ensure opponents cannot attend.
“This meeting comes at a critical time,” blogged Kate Mitchell with the Maternal Health Taskforce. “The global health community is facing big questions about what sort of development goals or framework will follow the MDGs [Millennium Development Goals] and whether resources will be allocated to or diverted away from maternal health.”
A requirement for global abortion coverage would contravene the outcome documents from the Cairo and Beijing conferences, as well as the choice of member states to reject any mention of “reproductive health” in the MDGs in 2000 and 2005 – including MDG 5 to reduce maternal mortality – precisely because they feared the phrase could be used to include abortion.
Horton insists that “we must broaden that maternal mortality goal to include the realization of political, economic, and social rights for women.” This emphasis on rights was echoed by Harvard professor Alicia Yamin, who advocated a human rights-based approach to “identify rights-holders and their entitlements and corresponding duty-bearers and their obligations” rather than a public health approach which focuses on identifying a health problem such as maternal mortality and “proposes to address that problem within the societal framework.”
While maternal mortality rates continue to fall – the recent Global Burden of Disease study cites a 47.2% drop in the global maternal death rate since 1990 – there is scant research to link this trend to liberalization of abortion laws. Insistence on access to abortion as a human right rather than a medical necessity sidesteps this issue.
The titles of the conference talks frequently referred to “creating demand,” “improving demand” or “empowering women to demand” improved maternal health care products and services, phrasings which suggest that the agenda being driven by the attendees is not in line with what the women being targeted actually want. One presentation, given by a representative of Population Services International, was titled “Creating the misoprostol market,” referring to the drug used for both postpartum hemorrhage and medical abortion.
Horton’s manifesto calls for new measurements and accountability regarding maternal outcomes. The insertion of abortion as an essential part of the post-2015 agenda cannot be supported by any existing measurements, and dramatic improvements in maternal health have already been achieved without it. Abortion advocates are demanding as a right what cannot be justified by the data in the hopes of obtaining institutional cover and secure funding within a new global development agenda that, at this time, will not have an expiration date.