Views & Reviews

Lack of political will is a clinical issue

BMJ 2009; 338 doi: (Published 11 March 2009) Cite this as: BMJ 2009;338:b1013
  1. Tarek Meguid, consultant obstetrician and gynaecologist, Kamuzu Central Hospital and Bwaila Hospital, Lilongwe, Malawi
  1. meguid{at}

    “Medicine is a social science, and politics is nothing else but medicine on a large scale”

    Rudolf Virchow, founder of social medicine

    When we conduct verbal autopsies in the context of maternal deaths we try to uncover the “real” story behind the biological story.1 We try to understand not only how but also why this particular pregnant woman had a cardiopulmonary arrest.

    The “why” question is more important and relevant than the clinical question of how an otherwise relatively healthy but pregnant woman dies.2 Although it is important to know the clinical aspects of the more than 500 000 deaths of women during pregnancy and childbirth every year,3 it is more important to understand why a poor woman has a 1 in 13 chance of dying in childbirth while a rich woman has a 1 in 4100 chance.4 In medieval5 and later times6 in Europe a woman had an estimated 1 in 7 to 1 in 10 chance of dying in pregnancy and childbirth, the same as in some poor countries today.4

    There are many reasons why we healthcare workers shy away from the “why” questions. One is the feeling of uncertainty as to the truth of our proposed answers; another is our feeling of impotence when we realise that we can do much less about the reasons for those deaths than about the way in which they occur.7

    Effort is being made to understand the social, political, economic, legal, cultural, and other determinants of these premature deaths.8 Professionals from disciplines other than health9 are at the forefront of these efforts and are gradually being seen as brothers and sisters in arms rather than outsiders.10

    These women and girls die because they are poor, voiceless, and female.11 This …

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