Safe Motherhood and the 'Conspiracy of Silence'
ZENIT: It has been 15 years since the World Health Organization's Safe Motherhood conference in Nairobi. How much progress has there been?
Walley: Certainly there has not been enough progress. It is an international disgrace that mothers in poor countries, at the beginning of the 21st century, should be experiencing unimaginable suffering, due to a scandalous lack of effective care during pregnancy and childbirth which is resulting in 600,000 dying annually.
Mothers are dying alone in small villages a few at a time, commonly from hemorrhage, obstructed labor, pregnancy induced hypertension and — yes, we must realize — even from induced abortions. However, these deaths represent the tip of the iceberg.
It is estimated that for every death, 30 more suffer long-term damage to their health, for example, from obstetric fistulae arising as a consequence from neglected obstructed labor. The result is that the baby dies and, because of damage to the bladder and rectum, the mother becomes incontinent with regard to urine and-or feces, and thus becomes a complete outcast and is treated worse than a leper by her husband, family and society, simply because she is wet and offensive to them.
Such mothers suffer pain, humiliation and lifelong debility if not treated. There are estimated to be 2 million mothers with the condition, mostly in sub-Saharan Africa; 50,000 to 100,000 are added each year. The tragedy is that most of this mortality and morbidity is preventable with proper maternity care, and obstetric fistula can be treated surgically, but at present there are not enough trained doctors, nurses or adequate facilities.
The 1987 Safe Motherhood Conference in Nairobi first drew attention to this tragedy experienced by mothers and issued a call to action. The response from the international community so far has been insufficient, and the reason for this inaction, according to UNICEF, is a "conspiracy of silence" and a "lack of initiative," to which must be added a lack of compassion and political will and a reliance on abortion and contraception to the exclusion of emergency obstetrical care.
The U.N. Charter of Human Rights states that the right to health care is basic. The Beijing Conference on Women identified 12 critical areas of concern, one of which was the right of women to the "highest attainable standard of physical and mental health." It is time for the international community to invest in the needs of the millions of women in developing countries who wish to become mothers and to stop discriminating against them.
Q: What types of care does your organization's work bring to Third World women?
Walley: We are introducing programs which consider the needs of mothers, [such as the] West African Maternal Health project. Begun in 1998, this demonstration project is located in the Diocese of Sunyani, in a rural area of Ghana, West Africa.
MaterCare has developed an essential obstetrical care service for a rural area consisting of programs designed to improve the survival of mothers by training traditional birth attendants — TBAs — who are responsible for 70% of all deliveries, to recognize and refer high risk mothers to our district hospital, using a pictorial antenatal card; by improving the care given to mothers in rural maternity centers by nurse/midwives using a labor partograph; by introducing a safe and efficient means of transporting mothers with obstetrical emergencies to the district hospital; and by providing a maternal blood transfusion service.
We believe that this model can be used in any developing country, and we have been asked to consider developing these programs in Sierra Leone and East Timor.
A basic research program is under way to evaluate an oral, effective and inexpensive method of managing postpartum hemorrhage, one of the main causes of maternal mortality. If these studies prove successful, the final objective is to develop protocols for the use of misoprostol by traditional birth attendants, who do most of the deliveries in life-threatening situations, when medical help is not available. We think it could be a major breakthrough in preventing maternal deaths.
A West African Regional Birth Trauma Center is being developed in the Archdiocese of Cape Coast, Ghana, which will provide treatment and rehabilitation programs for mothers with obstetric fistula, and will have a special interest in training doctors and nurses in their surgery and nursing management. Other centers are needed in other parts of west Africa including again Sierra Leone and Rwanda.
A training CD has been developed for surgery and nursing for obstetric fistula. It is available free of charge to doctors and nurses in areas where fistulae are common. We tried to provide emergency obstetrical care in East Timor, but were denied access by the U.N. administration because we would not provide abortion and sterilization programs. We explained that we did not provide these services as they were irrelevant to mothers who are bleeding to death, or are in obstructed labor. We also pointed out that we do not treat rheumatoid arthritis either!
I must point out that there is no international organization that provides emergency care for refugee mothers. Médecins sans Frontières does excellent work in front-line areas, as does the International Red Cross. We believe that there is a place for such an organization as ours, since half of all refugees are mothers, most are young and it is fairly easy to calculate the numbers who are pregnant and who face possible pregnancy complications in addition to bombs, guns or natural disasters. MCI is trying to develop itself to fill a vacuum.
Q: At your recent conference in Rome, many leaders from Third and First World countries addressed medical, political and faith issues touching on the lives of Third World women and children. What do you think this meeting of minds is likely to produce?
Walley: First of all, may I just correct the term "conference"? This was the second workshop. The difference is important, in that it was a "shirt-sleeve meeting," designed not simply to talk but to get on and do things. Also, a medical conference conjures up the image of expense, of corporate sponsors. This was a low-key affair, in a beautiful retreat house, close to St. Peter's, where we worshiped, lived and discussed together for four days.
MaterCare has from the beginning adopted — using the words of Vatican II — a "preferential option for mothers" wherever they may be, as frequently mothers are of the poorest of the poor. Our mission is to provide mothers and babies both born and unborn with the best of medical care, based on life, hope and love, rather than the death and despair which is abortion, through new initiatives of essential obstetrical service, training of health workers, and research based on the ethics of "Evangelium Vitae."
We are demonstrating that, as Catholics, we can provide relevant health care for mothers. With that mission, we have become a unique professional organization, albeit in the embryonic stage of development.
We are challenging the medical status quo that bases the care of mothers on "reproductive health" — a euphemism for abortion and birth control. Thus, we have few friends in governments, international health agencies or the professions. We need all the help we can get from colleagues and friends.
Q: You planned to meet with the Pope after your workshop. What does he have to say regarding your organization and its work?
Walley: While we actually did not meet with the Holy Father this year due to his busy schedule, we had very much in mind his words to obstetricians from the closing audience last year, that "their profession has become still more important and their response will be still greater in today's culture and social context, in which science and the practice of medicine risk losing sight of an ethical dimension, in which health care professionals are strongly tempted at times to become manipulators of life and even agents of death."
He concluded his address by issuing a challenge to the whole Church: "It is my fervent hope that, at the beginning of this new millennium, all Catholic medical and health care personnel, whether in research or practice, will commit themselves wholeheartedly to the service of human life. I trust that local churches will give due attention to the medical profession, promoting the ideal of unambiguous service to the great miracle of life, supporting obstetricians, gynecologists and health workers who respect the right to life, by helping to bring them together for mutual support and the exchange of ideas and experiences."
These challenges were reinforced again this year in various keynote address and homilies, given by the presidents of various congregations and councils.
Q: The mortality rate for expectant mothers in Africa is as high as 1 in 16. Yet almost all the Western aid money for "reproductive health" is spent on contraceptives and abortion. Why is this?
Walley: Most mothers in developing countries are poor and uneducated and have no voice to speak on their behalf. It is true that billions of dollars are spent on reproductive health and population control. AIDS and injuries from land mines are serious problems, but they are also political diseases. Maternal mortality is not of political importance, so there is neither the political will nor compassion to do what is needed.
Little is spent on providing women who want to be mothers with emergency obstetrics when complications arise. The West, in our view, is denying poor mothers their human right to adequate health care during pregnancy and childbirth when complications arise, and is thus discriminating against them.
Q: Does the appalling neglect of health for Third World mothers stem from an underlying assumption in Europe and the United States that pregnancy itself is the problem?
Walley: There is an antipathy toward motherhood in general in the West. Mothers in developed countries do have access to the best of care and thus maternal mortality and morbidity ratios are very low. We want the best for ourselves, but not for the poor in developing countries. It is an international disgrace that not enough is being done about the situation.
Q: Yet millions are spent in the First World on fertility treatments. The Western response seems almost explicitly racist.
Walley: I do believe it is racist. The conclusion that any reasonable person must come to, after reviewing current world maternal mortality, morbidity and abortion statistics, is that the world cares very little for mothers and their unborn children.
At this time of the year, we are forced to consider again the birth which brought about the most important event in human history, the Incarnation. Pope John Paul II, in his millennium letter, reminds us that we also celebrate the most important motherhood ever: "The Father chose a woman for a unique mission in the history of salvation: that of being the Mother of the long awaited Savior. The Virgin Mother responded with complete openness."
Motherhood has special significance for all Christians. Obstetricians and midwives share a unique and privileged vocation in the service to life. However, two of the greatest tragedies of our times concern the suffering and deaths of hundreds of thousands of mothers, and the deliberate killing of millions of unborn children. MaterCare won't change the world, but we think we can make a bit of a difference.
ZENIT is an International News Agency.
© 2003, Innovative Media, Inc.
This item 4550 digitally provided courtesy of CatholicCulture.org
