Here is how gender norms drive high death rates for women giving birth

The 2024 State of the World Population Report published by the United Nations Population Fund (UNFPA) makes a stunning revelation that  there has been zero reduction in maternal mortality since 2016, and that rates are rising in a number of countries.

 UNFPA operates in more than 150 countries with the goal of eliminating “preventable maternal death.”  The Maternal Mortality Rate (MMR) is the annual number of female deaths per 100,000 live births from any cause related to or aggravated by pregnancy.

 In 2020, it was estimated that  the 20 countries with the highest MMR in the world are all in Africa, with the exception of Afghanistan. South Sudan has the highest maternal mortality rate globally at 1,223, followed by Chad at 1,063 and Nigeria at 1,047. Other African countries in the top 20 are Central African Republic, Guinea Bisau, Liberia, Somalia, Lesotho, Democratic Republic of the Congo, Kenya, Benin, Burundi, Cote D’Ivoire, Mauritania, The Gambia, Siera Leone, Niger and Mali.

 While there are a multiplicity of reasons for persistent high MMRs, #GenderCoversations contends that gender and social norms contribute to the situation as they permeate individual, societal and governmental systems.

For instance, despite the awareness that child marriages is a harmful practice, it remains prevalent and can lead to early childbirth, which is often associated with complications due to young mothers being unable to take appropriate decisions, or just because their bodies are not ready.

The UNFPA WPR notes that “Gender-unequal norms remain embedded in health-care infrastructure, including persistent underinvestment in the predominately female midwifery workforce.”  

In societies where the norm is that a woman should have enough children to be named after all eligible ancestors, women are pressurised to have as many children as possible, leading to higher risks of mortality. In other societies, mothers are expected not to “fear” giving birth or else they are labelled as cowards. This discourages them from seeking professional help during childbirth, which exposes several women to danger if they need emergency care. Some gender norms promote home deliveries, which increases the risk of complications.

 In contexts where women and girls are excluded from economic opportunities, their incomes may be inadequate to support their ability to seek health care. When combined with gender norms that restrict mobility of females, unless they are accompanied or approved by a male family member, potential risks may arise.

In future, it will be crucial to take a holistic approach to improve health systems while addressing gender norms that negatively affect maternal health outcomes.  In addition to changing attitudes and empowering individual women to seek maternal health services, it will be critical to address norms that curtail the mobility of females compared to males.

It is important to address norms that deny certain genders control over income, along with those that restrict decision making on the bodies of women and girls.

At a systemic level, policy must incorporate a shift in gender norms to eliminate preventable maternal deaths.