Motorcycle dowries? An economic look behind maternal mortality in girls

I just read yesterday’s article on the BBC website about UNICEF’s bike ambulance program in South Sudan. UNICEF has donated five motorbikes, each costing $6,000 (£4,100) , as part of a pilot scheme for transporting women in labour to a health care facility. The bikes are outfitted with a padded side-bed that can fit two, and powerful suspension to cushion the jarring effects of the rough road tracks.

The program was inspired by a similar one in Malawi that has helped to cut the maternal mortality rates by more than half over a period of four years.

That’s an impressive result. It struck me as a clear illustration of just how essential health care is to women and their communities. And that simple, cost-efficient solutions, with a bit of creativity, can go a long way.

But something was not quite adding up. Here are some facts from the article:

• A woman has a one-in-six chance of dying during pregnancy during the course of her lifetime in this underdeveloped region, according to the United Nations
• A 15-year-old girl is more likely to die in childbirth than to complete school
• In South Sudan, girls often give birth at a young age, meaning complications in pregnancy are all too common

What is wrong with this scenario? Before the arrival of the bikes, chances were quite high that a young girl in South Sudan will die or suffer from a complicated childbirth. Without access to resources, training, or transportation, communities have little recourse to address this problem.

Or do they?

One obvious solution that requires no technology, money, resources or outside intervention is to delay the marriage of girl children. Why has this change not been implemented? What is driving the necessity of marrying girls at young ages? And whose decision is it?

I have not researched the situation in this part of Sudan, but a common reason generally behind child marriage is economic: families cannot afford to keep their daughters for very long (they are mouths to feed and are not income-generators), and/or marriage offers the opportunity for exchanging the daughter with a commodity, like some livestock, or even money, which could mean the difference between life and death for a family. This 1:14 minute youtube clip posted by the Girl Effect about the prospects of an 11-year girl in Ethiopia is telling. Unfortunately, her story is not unique.

Again and again, it comes down to economics. Women and girls are economically disadvantaged, compared to their male counterparts, the world over. In the West, it is there in the form of the glass ceiling, the old boys clubs (of politics, sports, etc.), and domestic violence/rape. In poor countries, it has resulted in the “feminization of poverty“. According the UN’s Division for the Advancement of Women website (May 2000):

• the majority of the world’s 1.5 billion people living on one dollar a day or less are women
• the economic gap between women and men has continued to widen over the last decade
• world-wide, women earn on average slightly more than 50% of what men earn

Some reasons:

• women living in poverty are often denied access to critical resources such as credit, land and inheritance
• women’s labour is unrewarded
• women’s health care and nutritional needs are not given priority
• women lack sufficient access to education and support services
• women’s role as decision-makers at home and in the community is minimal

An outcome of the Fourth World Conference on Women (Beijing, 1995) is the recognition by governments that poverty has a gender dimension. This has led to many initiatives, such as micro-financing and improvement schemes targeted at women and women-headed households.

The irony behind the feminization of poverty, and its consequences such as child marriage (and thus girl-mother mortality), is that women are excellent and resourceful investors. According to this source, women and girls earning an income re-invest 90% of it back into their families, compared with 30-40% for men.

Equally ironic is the fact that women’s unpaid labour is the backbone of a community’s survival. I saw it in DRC when I visited there in 2007, where I watched women carry sacks to and from the market everyday, sacks so heavy that uterine prolapse is a significant health care problem. I was told that women can be treated worse than work animals: they must perform all the physical labour involved in running households and rearing children, provide for the sexual needs of their husbands on demand, they eat only after their husbands have had their fill, and have no say in the decisions made regarding the family or their own bodies.

Consider Tendai, a young girl in the Lowveld, in Zimbabwe. Her day starts at 4 a.m. when, to fetch water, she carriers a thirty litre tin to a borehole about eleven kilometres from her home. She walks barefoot and is home by 9 a.m. She eats a little and proceeds to fetch firewood until midday. She cleans the utensils from the family’s morning meal and sits preparing a lunch of sadza for the family. After lunch and the cleaning of the dishes, she wanders in the hot sun until early evening, fetching wild vegetables for supper before making the evening trip for water. Her day ends at 9 p.m., after she has prepared supper and put her younger brothers and sisters to sleep. Tendai is considered unproductive, unoccupied, and economically inactive. According to the international economic system, Tendai does not work and is not part of the labour force.

– Marilyn Waring [1]

But cultural change is a difficult ship to set sail. Some criticisms of micro-financing programs for women listed here cited an example of how such schemes may actually decrease women’s empowerment: infusing cash into local economies can increase dowries, forcing women to take microcredit loans as the only means to pay increased dowries for their daughters [2].

For now, it seems it is easier to invest $6000 for a motorbike that can save a girl’s life than overhaul the world’s economic framework.

1. http://www.unpac.ca/economy/unpaidwork.html

2. Jason Cons and Kasia Paprocki of the Goldin Institute, “The Limits of Microcredit—A Bangladeshi Case”, Food First Backgrounder (Institute for Food and Development Policy), Winter 2008, volume 14, number 4.