A Matter of Life and Death

Musimbi Kanyoro

The church need to get in touch with that hope and courage right now for the sake of women everywhere. Millions of lives are at stake.

I currently work in women’s health, the place where I try to emulate my ancient Hebrew sisters by taking the courage to ask for justice for women. Reproductive health problems are the leading cause of death for women of reproductive age in developing countries. Women are dying because of silence on this subject. The world’s lack of solidarity with women and the persistence of power dynamics – not a lack of medical solutions – determine which women live and which women die. The number of women globally who die from pregnancy-related causes each year is more than 500,000, while more than 300 million women live with illnesses due to pregnancy or childbirth. A staggering 99 percent of maternal deaths occur in developing countries.

Socioeconomic disparity determines who lives and dies. Consider that the lifetime risk of death from pregnancy-related causes in Canada is around one in 11,000, while in Afghanistan and Sierra Le- one the number is one in eight. Even within wealthy countries, the inequities are revealing. According to the Society of Obstetricians and Gynecologists, Canada’s average maternal mortality masks big regional variations; the reality for women in some rural and remote areas, particularly aboriginal communities, is disturbing. In the U.S., black women continue to be the most affected because of health disparities.

Survival rates for pregnant women depend largely upon the distance and time a woman must travel to reach skilled emergency medical care. According to the United Nations, factors increasing the high risk of maternal death can be blamed on delays in seeking care – for example, when a women must get permission from male family members to travel – as well as delays in reaching an emergency care facility because of a lack of transportation, or delays in receiving care when facilities lack sufficient staff, equipment, and affordability. Maternal mortality rates could be drastically reduced by improving women’s access to comprehensive reproductive health services and health education.

These statistics reflect gross inequities between rich and poor. For the women affected, they also rep- resent a serious infringement of basic human rights, including the right to the highest attainable standard of health services and information. And they mask a much wider societal impact. More than a million children are left motherless every year. Newborns whose mothers die from these preventable deaths are three-to-ten times more likely to die before the age of two than those whose mothers survive. Orphaned girls often are pulled out of school to fill the role of caregiver for other family members. This is why UNICEF refers to the “double dividend” of gender equality, one that benefits women and children both – and, indeed, society at large. 

Imagine living in a country like Malawi, in which you share your doctor with 50,000 others. People in thirty-six countries in Africa live a similarly grim reality, says the World Health Organization. Africa faces a shortage of 800,000 doctors and nurses, and currently trains only between 10-30 percent of the skilled health workers that are needed. With ag- ing populations, industrialized countries too are suffering a shortfall while the demand for health services is on the rise, a trend that drives up demand for trained hospital and clinic staff. Africa loses 20,000 trained health professionals every year to migration – this on a continent that already manages 25 percent of the global burden of disease with only 3 percent of the global health workforce.1

The result of this ruinous migration is that wealthy countries reap a benefit while poorer countries that helped finance education and professional training lose a return on their investment. But there are deeper social impacts in many countries, where the net loss of health workers can hasten the near- collapse of already fragile health systems.

My conscience is constantly on edge as I encounter the misery and death of women because of their reproductive capabilities. An estimated 200 million women worldwide want access to modern contra- ceptives but cannot get them, leading to 80 million unintended pregnancies each year. Nearly 350,000 women die each year because their pregnancies are too soon, too close together, or too many, or happen in unsafe conditions. One in five of these deaths are related to unsafe abortion.

Girls continue to lack educational access, especially at the secondary level, yet each year that a girl stays in school makes her less likely to marry early and more likely to plan for and space her children, use family planning, and get adequate medical care during and after pregnancy. Providing greater educational and economic opportunity to women is fundamental to improving their ability to make choices about their own fertility.

Meeting Ana

These are not just statistics. Real people exist be- hind them. I encountered Ana, who was feeding her six hungry children with dirty water and a little coffee powder because she could not afford any- thing else. I visited Ana in a poor slum in the vast city of Manila. She is 30 years old and has had nine pregnancies with spacing of no more than a year. She could hardly walk – overcome by exhaustion, hunger, and illness. She looks older than her age. Ana cannot space her children or limit them because the Church does not allow her to use contraceptives. She may die and her children too are vulnerable. She indeed already lost three children before their first birthdays.

There are millions of women like Ana all over the world. Why are they invisible to the church and the media? Why are they simply invisible?

Although the problems are daunting, the elements of a human rights response to health issues are straightforward, and the potential for positive change is enormous. The Universal Declaration of Human Rights states that “every individual and or- gan of society … shall strive … to promote respect for these rights … and by progressive measures … secure their universal and effective recognition and observance.”

Fulfilment of human rights – and justice for women – depends upon the actions of individuals and communities, the private sector, international organizations and religious leaders, not just governments. Human rights – including women’s human rights – are everyone’s responsibility. What if religions cared about justice for women? What if the churches could care? 

Musimbi Kanyoro is director of the Population Program of the David and Lucile Packard Foundation in Los Altos, CA. The Population Program focuses on reproductive health and the integration of those services with critical global health issues like HIV/AIDS. From 1998-2007, she was general secretary of the World YWCA, an umbrella organization for national YWCAs in 125 countries, with an outreach to 25 million women and girls and their families in 3,000 communities. She has also worked for the Lutheran World Federation, and is a former circle coordinator of the Circle of Concerned African Women Theologians.


1. The UN’s Millennium Development Goals pledge to reduce child mortality, improve maternal health, combat HIV/AIDS, malaria and other diseases, and develop a global partnership for development. With only four years remaining before the 2015 target date, many countries are still far from meeting these goals; the goal of maternal health is showing the least progress. Universal access to reproductive health is a key to achieving the MDGs because it aims not only to reduce maternal death but also improve reproductive health and quality of life for women before they become mothers and throughout adulthood.

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