New research from Johns Hopkins released this week suggests that one of the most effective ways we have to lower the maternal mortality rate would be simply to meet the unmet demand for contraception in developing countries, a move that researchers say could reduce the maternal mortality rate by as much as one-third. Public health researchers have been offering this as a solution for a long time, but unfortunately the power of the anti-choice movement in the United States and of the Catholic Church slows down implementation of programs that could help meet the demand. The pressure from anti-choice factions even kept Melinda Gates from admitting in public for a long time what should be obvious: When women who want contraception can't get it, bad things happen. Hopefully this new research will help trump the unevidenced hand-wringing from people who continue to believe that there's a chance to convince people worldwide to just stop having sex instead.
Most people, when you point out that contraception access reduces maternal mortality, respond with "no duh." You can't have a maternal mortality if there wasn't a pregnancy in the first place. Reducing the number of pregnancies reduces the number of maternal mortalities. But this formulation carries with it some uncomfortable implications, as if public health people are treating pregnancy itself as a problem. Which, in turn, gives credence to anti-choice arguments that pro-choicers think pregnancy is a disease. (We don't.) All of which is why it's important to understand that this isn't about reducing the number of pregnancies in an absolute sense, but targeting those pregnancies that women would usually prefer to prevent if they had the choice.
Whether or not a pregnancy is intended or not has a tremendous impact on the odds that it's going to be fatal, which means that even if the absolute number of pregnancies remained stable but the percentage of them that were unintended went down, you'd still see a substantial reduction in maternal mortalities. Sabrina Tavernise at the New York Times explains:
Birth control reduces health risks, the researchers said, by delaying first pregnancies, which carry higher risks in very young women; cutting down on unsafe abortions, which account for 13 percent of all maternal deaths in developing countries; and controlling dangers associated with pregnancies that are too closely spaced.
There are other ways to reduce these risks, of course. Legalizing abortion goes a long way to reducing the maternal mortality rate from unsafe abortion. Bringing an end to child marriage would go a long way to reducing the mortalities from women who simply give birth too young. But while these steps would do a lot of good, they would work even better in conjunction with providing contraception to women who want it but can't currently get it. Realistically speaking, getting contraception out to needy women is going to move a lot faster than ending child marriage or having safe, legal abortion available to every woman in the world.
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