In the familiar account of Jesus' birth, there is no mention of the fact that Mary delivered her firstborn without the help of medical personnel. Giving birth without skilled help was universal 2,000-plus years ago. It remains surprisingly common today.
The World Health Organization estimates that this year, 63 million women -- 45 percent of the 140 million women giving birth -- will deliver without medical assistance. This means that many women and even more babies will die because they lack rudimentary maternity care.
The highest rates of unattended deliveries and maternal mortality are in Africa, but a large number take place in areas not far from Bethlehem. More than 25 percent of the women in neighboring Egypt will deliver without professional medical help. The numbers are far worse in the poorer countries in the region. In Yemen, for example, three-quarters of mothers will deliver without help. As a consequence, they will die at an alarming rate. The lifetime risk of dying in childbirth in Yemen is 1 in 20; in the United States, it is 1 in 2,500.
In addition to the lack of maternal care, many of these new births will be unintended because the mothers couldn't protect themselves from pregnancy. They lacked access to effective contraception -- specialists estimate that over 200 million women are in this situation -- or could not successfully manage traditional methods of contraception with their partners.
Last July, representatives from developed and developing countries met at the London Summit on Family Planning and pledged to increase funding for family planning programs. Their goal is to provide high-quality contraceptive services by 2020 to 120 million women who are currently without them.
The summit yielded both new money and new momentum for the family planning field. Financial pledges totaled more than $2.6 billion. The event generated a great deal of enthusiasm among reproductive health advocates, who have seen family planning sit on the back burner for the past 20 years as other health and development priorities gained attention from donors, governments, and NGOs.
The new funding pledged during the summit was very welcome. From 1995 to 2007, international support for family planning fell by half -- from $723 million to $338 million. The rise of HIV, worries about coercive practices, and the sense that high fertility and rapid population growth were no longer pressing issues all contributed to the lack of support for family planning.
As a result of the loss of funding and too little action on the part of developing-country governments, poor women in poor countries are still without easy access to family planning. Their risk of unintended pregnancy is unacceptably high. And most lack access to skilled birth attendants, so their risk of complications or death during childbirth is also high.
To save lives and improve women's health, developing-country governments need to upgrade their services, and that takes money. We know what women want, and we know how to increase their access to contraceptives, thereby improving their health by reducing the number of unintended pregnancies.
Women need high-quality services, and national family planning programs need political support. Finding and staying with the middle ground is crucial in both cases. Women's rights and choice need to be put first. Governments and private-sector organizations should commit to ensuring that all women have the choice of a range of contraceptive methods, and that the poorest women have the same access to high-quality reproductive health information and services as women who are better off.
Too-ardent political support, for example when provincial authorities are told promotions are dependent on the number of new contraceptive users, must be avoided because they can lead to overly aggressive services. Instead services should be completely voluntary.
This Christmas, think of the difference that high-quality reproductive health care and access to contraceptives could make to the 63 million women giving birth each year without proper help. Over 150,000 of them will deliver a baby on Christmas Day in circumstances heartbreakingly close to what women experienced in Mary's time. Say a prayer for them, and say a prayer for the specialists at the London Summit on Family Planning that they may spend the new resources wisely. With new funding, new energy, and new support for family planning, more women and their children will survive.