Global health priorities and women: Why is the ‘M’ in MCH?

The global health world loves acronyms – it’s almost impossible to have a discussion about global health organizations and their work without using a smattering of insider-y abbreviations. For example, when discussing the progress by NGOs and WHO towards MDGs related to MCH. The one acronym in that sentence that irks me the most is the last, MCH, or maternal and child health. My opposition to this acronym is twofold. One, it seems that when development organizations talk about women’s health and mortality it is usually only in relation to their status as mothers – maternal health. Two, as Rosenfield and Maine point out in “Maternal mortality – a neglected tragedy,” the causes and cures of maternal (or non-maternal women as the case may be) disease and death hardly overlap at all with the causes and treatments of child death.[1] To constantly address these two distinct categories as though they are one is to deprive both women and children of the attention and resources they deserve.

The authors of the articles assigned for the “reproductive health” lecture all make the assertion that not enough resources are being spent to prevent maternal death – that is, women who die as a result of pregnancy or childbirth. I agree that it is heartbreaking that in this day and age, so little is being done to prevent the illness and death that often results from a condition that only affects women: pregnancy. But what I find even more reprehensible is that pregnancy-related diseases and mortality are the only instance where women’s life and health even merits attention. Even the Millennium Development Goals (MDGs) seem to make this blunder. MDG 5 addresses “maternal health” – women dying as a result of pregnancy and childbirth. Some of the indicators from MDG 5 do address contraception and family planning, but again this is done under the heading of “maternal health,” implying that women who access contraception are doing so only to time and space their pregnancies, or that they are already mothers. I would rather see these items under the heading “sexual health” – that’s how I would classify providing contraceptives to someone who wants to have sex without getting pregnant. Some women may not wish to ever have children – do they still fall under “maternal health” or are they just ignored? The fact that this term is often used interchangeably with “women’s health” seems to suggest that women are still seen only in terms of their capacity to bear and raise children, not as people worthy of life and health in their own right.

MDG 3 focuses on “gender equity,” and this is the category that I feel is better suited to address inequities in health related to death from unsafe abortion or unmet contraceptive need. However, MDG 3’s indicators are all related to proportion of women in education, the workforce and the government. The Lancet article, “Maternal mortality: who, when, where and why,” addresses some of the less obvious causes of so-called “maternal” death such as death from unsafe abortion (accounting for up to one-third of “maternal” deaths in a study in Benin, Cote d’Ivoire and Senegal[2]), suicide or domestic violence. To me, these causes of death among women should clearly be classified as gender inequality and addressed as such, not merely classified as a side-effect of pregnancy. Global health interventions aimed at averting “maternal mortality” will do nothing to end domestic violence aimed at pregnant women, the hopelessness felt by women who never wanted to be pregnant in the first place or the lack of access to safe and legal abortion.

To continue using the category “MCH” to address the varied and distinct health concerns of non-pregnant women, pregnant women and children is to further conflate “women and children” as one category, in opposition to “men” or just “people.” It paints women as analogous to children, somewhat weak and helpless, and gives them an identity inextricably tied to child-bearing and child-rearing. Interventions aimed at increasing access to family planning and skilled birth attendants do not belong in the same category as nutrition interventions and treatment of childhood diarrhea. If these interventions had their own separate categories and specialists, they might each thrive. Let’s stop looking at all health issues affecting women through the lens of “motherhood” or “MCH” and focus on gender equality, sexual health, children’s diseases and safe pregnancy and childbirth as separate issues.

[1] Rosenfeld, A, Maine, D. (1985) “Maternal Mortality – A Neglected Tragedy.  Where is the M in MCH?” Lancet, July 13, 1985.

[2] Ronsmans, C, Graham, WJ. (2006) “Maternal mortality: who, when, where, and why.” Lancet 368: 1189-1200.


One response to “Global health priorities and women: Why is the ‘M’ in MCH?

  1. Definitely agree! You might enjoy this video I made with students at the Millennium Campus Conference in October, which also goes to your point about the dangers of conflating maternal and child health in program monitoring and evaluation:

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