Is Maternal Health an Issue of Security?

child-health
Image obtained from: http://www.downtoearth.org.in/news/india-among-worst-performers-in-maternal-and-child-health-44268

Billions of dollars are being invested in complex scientific research for the benefit of mankind. I recently came across an article- Scientists use gene-editing technology to knock out genes in human embryos for first time in order to study how embryos develop. This new development took over the headlines just last month (September 2017)1. I spent a considerable amount of time with my colleagues, discussing the potential of this technology in understanding the role of specific genes in embryos and how it is just a start to more groundbreaking medical discoveries in our near future.

mmr1.jpg
Infograph of distribution of maternal mortality around the world; Image obtained from: https://visual.ly/community/infographic/health/maternal-mortality-world

While news like this makes me proud of our progress in science, some statistics leave me in dismay. To date, more than 350,0002 women die annually due to pregnancy related complications of which,  99%3 of the deaths occur in developing nations, mainly in sub-Saharan Africa and South Asia. Fortunately, most of these deaths are preventable if sufficient funds and resources are allocated. Furthermore, knowledge and technology to eradicate maternal mortality is abundant. It is unacceptable that this issue is not being dealt with high importance. If ample funding can be invested in studying complex genetic diseases (which of course, is clearly important), why are we overlooking the millions of women whose lives could have been saved if not for our sheer negligenceClearly there is a severe lack of resources and funding especially in developing nations, which makes this a pressing and urgent issue4.

Healthcare is a basic human right. The World Health Organization (WHO) defines the right to healthcare as “the highest attainable standard of health as a fundamental right of every human being”. It is therefore, the basic right of every mother to have a safe delivery.Will securitizing maternal health help to alleviate this problem? I strongly believe so but several other factors such as research, empowerment of women and training of local leaders need to complement securitization, which I will discuss later.

mmr2Infograph on predominant causes of maternal mortality; Image obtained from http://www.womenandncds.org/resources/partner-resources.html

Securitization

The Copenhagen School first developed a theoretical framework for securitization of an issue. First, an actor (political leaders, bureaucracies, governments, lobbyists, pressure groups or international organizations) identifies an existential threat which then needs to be accepted as a threat by the audience (society). Finally, emergency reallocation of funds and resources is made by the actor to tackle the threat. If the threat has been rectified, the issue can be de-securitized but a persistent issue can then be incorporated as part of a policy and resource allocation will continue.5

After the Cold War, public health issues gained new attention as a threat to security, which led to increased political relevance and funding. The traditional definition of security was expanded to include threats that affect individuals. The United Nations (UN) must take the lead in securitizing maternal health just like they did for HIV/AIDS in 2000 and member states need to ratify the agreement. Since maternal or infant mortality does not spread transnationally like HIV/AIDS, Ebola, SARS, H5N1 and other contagious diseases, it may not be a threat to national security. However, it is a local security threat as it compromises the safety, health and life of women and infants. Therefore, it acutely diminishes their quality of life and requires immediate attention. Moreover, improving maternal health is part of the Sustainable Development Goals (SDG3), to ensure good health and well-being, making it a global responsibility to ensure that we reach this target. However, progress with maternal mortality has been one of the slowest and below the target since funding for maternal health has never gained political relevance as it does not directly impact governance or political power.

baby1.jpgImage obtained from: http://www.macleans.ca/politics/ottawa/a-matter-of-life-and-death/

Although the information and facilities required to prevent maternal mortality are well known, access to antenatal care, appropriate skilled care during childbirth, postnatal care and safe abortion is highly inadequate. The timely management and treatment are critical in saving lives of mothers and babies;6 infant mortality has a strong and direct correlation with maternal mortality. Along with the lack of funding and attention from the government, women do not receive sufficient care due to poverty, long distances from skilled healthcare and lack of information on care during and after pregnancy among others.6 These barriers have to be broken in order to address maternal mortality.

The obligation for securitization falls on international organizations like the UN for allocation of funds because many developing nations in Sub-Saharan Africa and South Asia are still submerged in poverty. Moreover, securitization is a political path and it is important to highlight that these developing nations are suffering from political instability and unrest. For instance, Afghanistan is facing post-conflict problems, leading to weak institutions and diminished political credibility. Unfortunately, countries from these regions fill up the ranks of the most corrupt countries in the world, making South Asia the world’s most corrupt region7. Simply providing aid to governments in silent prayer that it will reach the women who are losing their lives is counter-productive. Rather, it will provide more funds to feed the cancer of society: corruption. Hence, it is critical that securitization involves military participation, which can work independently to rapidly build infrastructure such as roads, hospitals, delivery of medication and information to enhance accessibility of maternal healthcare. 

baby 2.jpgImage obtained from: https://www.unicef.org/maternalhealth/index_588.htm

Drawbacks of securitization?

It is important to note that such an issue has not been securitized before. Hence, available research on the outcomes of securitization is scarce.4 A cookie cutter solution cannot be applied to all countries. Nationwide studies and research need to be conducted by the UN in partnership with international healthcare/pharmaceutical companies like Roche and Merck and local non-governmental organizations (NGOs) to understand the unique shortcomings each country faces. This will enable funding and resources to be allocated optimally to prevent over- or underfunding. Moreover, if maternal health is securitized, it could lead to the feminization of women’s security,4 which is essential, as status quo would have men making healthcare decisions on women’s health issues from a masculine lens. This clearly highlights the gender disparity we are still facing. Empowerment of women at both the local community and government level is essential for their presence at the decision making table. Their voices in formulating appropriate policies, which directly impact women are indispensable.

Scholars have argued that securitization may not be the optimal as the attention is diverted away from people who are suffering (civil society), their needs and rights towards military and intelligence organizations.8,9 I do acknowledge that maternal mortality cannot be resolved solely with the involvement of the military. Collaboration and communication between the civil society and the military is key. It is also important that international organizations and companies train local leaders in healthcare to equip them with the necessary skills required to manage maternal health effectively in their absence. Local leaders should be the main players in community healthcare while international organizations should be training them at the sidelines, because this ultimately is their game to navigate. Active involvement of local leaders is pivotal in such policy implementation due to the trust and credibility they harbour among local communities. They are essential for the mobilization of people to actively seek maternal healthcare services, which is crucial to save the lives of mothers and their babies. Information dissemination and building awareness in these communities are also best handled by the trusted local community leaders.

baby 3
Image obtained from: https://www.wilsoncenter.org/program/maternal-health-initiative

Securitization is therefore, essential for appropriate fund and resource allocation but military assistance to solve maternal mortality should not be permanent. Rather, military involvement should be withdrawn after maternal healthcare is successfully implemented and be left to public health organization and trained, well-equipped local leaders for continuous efforts. Securitization would have built the previously lacking infrastructure, which can then effectively deliver healthcare resources to women.

There certainly are challenges in securitization of health issues as noted previously, where it leads to public hysteria and the protectionist, ‘us vs them’ mindset. Unease caused during the avian influenza outbreak, resulted in the U.S closing its borders and spending millions of dollars inside the country to prevent the spread of the disease to its shores while ignoring the centre of the pandemic, which was Asia.10 However, this sceptic view does not hold with regards to maternal mortality since it is not contagious and there is no human-human transmission or trans-national spread. Hence, it is unlikely that fear will be the limiting factor. Rather, securitization will enable the building of awareness of the issue, the available resources to prevent it and the measures that need to be implemented.

Securitization in the past has also caused a lack of global co-operation as it has been argued that securitization benefits primarily the developed nations.11 Developing nations do not have the infrastructure to deal with such emergencies and believe that securitization aims to protect the needs of developed Western nations.12 However, the contentions between developed and developing nations are also invalid in context of securitizing maternal healthcare to eradicate maternal mortality as this is primarily a crisis of the developing nations.

Given that the main obstacles that hinder maternal healthcare is the lack of resources and allocation of funding, securitization is the most strategic route to take. Securitization will allow prompt action and allocation of funds, which will aid in the rapid eradication of maternal mortality since knowledge and research is abundant and hence, preventable. While we leap forward with new breakthroughs in medicine, our progress needs to be built on solving basic health issues globally. Like Gordon B. Hinckley said, ‘You can’t build a great building on a weak foundation. You must have a solid foundation if you’re going to have a strong superstructure.’ We must urgently eradicate maternal mortality, something that we have left unnoticed for too long.

References:

  1. Vogel, G. (2017, September 20). Scientists use gene-editing technology to knock out genes in human embryos for first time. Retrieved from http://www.sciencemag.org/news/2017/09/scientists-use-gene-editing-technology-knock-out-genes-human-embryos-first-time
  2. Richard Horton, “Maternal Mortality: Surprise, Hope and Urgent Action,” The Lancet 375.9726 (2010).
  3. Maternal, newborn, child and adolescent health. (2011, April 24). Retrieved from Maternal, newborn, child and adolescent health. (2017). Retrieved from http://www.who.int/making_pregnancy_safer/topics/maternal_mortality/en/index.html
  4. Baringer, L., & Heitkamp, S. (2011). Securitizing Global Health: A View from Maternal Health. Global Health Governance Journal, 21.
  5. Buzan, B., Wæver, O., & De Wilde, J. (1998). Security: a new framework for analysis. Lynne Rienner Publishers.
  6. Maternal mortality. (2016, November). Retrieved from http://www.who.int/mediacentre/factsheets/fs348/en/
  7. Becker, S. (2017, March 14). These Are the 15 Most Corrupt Countries in the World. Retrieved from http://www.cheatsheet.com/culture/ranking-worlds-corrupt-countries.html/?a=viewall
  8. Elbe, S. (2006). Should HIV/AIDS be securitized? The ethical dilemmas of linking HIV/AIDS and security. International Studies Quarterly, 50(1), 119-144.
  9. O’Manique, C. (2005). The “securitisation” of HIV/AIDS in Sub-Saharan Africa: a critical feminist lens. Policy and Society, 24(1), 24-47.
  10. Bigo, D. (2002). Security and immigration: toward a critique of the governmentality of unease. Alternatives, 27(1_suppl), 63-92.
  11. Harman, S., & Williams, D. (2013). Governing the world?: cases in global governance. Routledge.
  12. Rushton, S. (2011). Global health security: security for whom? Security from what?. Political Studies, 59(4), 779-796.