NICHOLAS D. KRISTOF: Prudence’s Struggle Ends

YOKADOUMA, Cameroon

As Prudence Lemokouno lay on a hospital bed here, spitting blood, her breath coming in terrible rattles, it was obvious that what was killing her wasn’t so much complications in pregnancy as the casual disregard for women like her across much of the developing world.

Neither Western donor countries like the U.S. nor poor recipients like Cameroon care much about Africans who are poor, rural and female, and so half a million such women die each year around the world in pregnancy. It’s not biology that kills them so much as neglect.

I began Prudence’s story in my column last Sunday, and for a while I thought I would have a happy ending.

Intellectually, I knew that women in Africa had a 1-in-20 lifetime risk of dying in childbirth. But it was wrenching to see this young mother of three fade and die so needlessly.

There’s no doubt that if men were dying at this rate, poor and rich countries alike would make the issue a priority, but the problem seems invisible, like the victims.

The U.N. Population Fund has a maternal health program in some Cameroon hospitals that might have saved Prudence’s life, but it doesn’t operate in this region. And it’s difficult to expand, because President Bush has cut U.S. funding for the population fund — even for African programs — because of false allegations that it supports abortions in China.

That’s shameful. Two women have tried to recoup American honor by starting a group, 34 Million Friends of U.N.F.P.A., to make up the shortfall with private donations.

(I discuss some of the groups active in this area at nytimes.com/ontheground, and I’ll also have a link to video of Prudence.)

Neither left nor right has focused adequately on maternal health. And abortion politics have distracted all sides from what is really essential: a major aid campaign to improve midwifery, prenatal care and emergency obstetric services in poor countries. We know exactly how to save the lives of women like Prudence, partly because a few countries like Sri Lanka and Honduras have led the way in slashing maternal mortality.

Lynn Freedman, head of the Averting Maternal Death and Disability program at the Mailman School of Public Health at Columbia University (www.amdd.hs.columbia.edu), notes that we could provide all effective interventions for maternal and newborn health to 95 percent of the world’s population for an additional $9 billion per year.

Sure, that’s a lot. But think of Prudence and women like her dying in childbirth at a rate of one a minute — and after all, the world spends $40 billion a year on pet food.