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Priorities for nutrition interventions in reproductive health: a bilateral agency perspective

Each year over half a million women in low-income countries die from complications associated with childbearing. Millions more suffer pregnancy-related morbidities and chronic long-term disabilities related to pregnancy and childbirth. These compromise a woman’s health and well-being and her ability to play an active role in her country’s development. Many of these problems have their roots in poor nutritional status (World Bank, 1993). It has often been said that the actual time of gestation is not a discrete 9 months but in fact a generation’s experience, that is, at least 20 years. Statistical analysis reveals that: women who give birth before age 18 years are three times more likely to die in childbirth than those who give birth between ages 20 and 29 years; for women over 34 years, the risk of maternal mortality is five times as high; first births are often riskier than second or third births, but, as parity rises, the risk of maternal mortality also increases. Almost 30% of pregnancies end in abortion, giving a total of about fifty-five million abortions in the world each year; most of these are performed under unsafe conditions. As a result, about 60 000 women per year are estimated to die from unsafe abortions (World Bank, 1993). The International Safe Motherhood Conference held in February 1987 in Nairobi, Kenya, launched the Safe Motherhood Initiative with the challenge ‘Where is the M in the MCH?’ (where MCH represents mother and child health). Nearly 7 years later we are still asking the same question, despite the fact that many agencies including our own have identified reproductive health as an emphasis area for funding of programmes. Recent international conferences including the 1990 World Summit for Children and the International Conference on Nutrition (ICN) in 1992 (US Agency for International Development, 1992), identified several goals to be achieved by signatory countries by the year 2000. Specific attention to the situation of women is included in these, i.e. reduction of the maternal mortality rate by half; reduction of Fe-deficiency anaemia in women to two-thirds of the 1990 levels; special attention to the health and nutrition of pregnant and lactating women; access for all women to prenatal care, trained attendants during childbirth, and referral for high-risk pregnancies and obstetric emergencies; maintenance of a high level of immunization coverage against tetanus for women; empowerment of all women to breast-feed their children; access by all couples to information and services to prevent unwanted and unsafe pregnancies; reduction in the adult illiteracy rate to at least half the 1990 level, with emphasis on female literacy (US Agency for International Development, 1992).