The 10 decisions every mother must be free to make

Irrespective of the circumstances of her birth, the most powerful decision-maker in a baby’s life is not a doctor, a teacher, a government official, or a religious figure, but her mother. As powerful as these traditional authorities may be, it is a mother who decides whether or not to continue with a pregnancy, how to nourish herself and her child, when to respond if a child is sick, and how to nurture a child’s development in the early years.

When mothers have the right knowledge and tools to exercise their power, babies can thrive. However, when mothers are restricted in any way – by lack of education, limited financial clout, no or low agency in the household, discriminatory legal restrictions, or lack of access to services – their own health and their baby’s health can be at grave risk. 

Seen in this light, many of our major development challenges, from reducing deaths in pregnancy and childbirth to ending newborn mortality and child malnutrition, are actually outcomes of mothers lacking the instruments to exercise their own power. With just a few tools – a high school education, a paid job, access to contraception, decision-making power in the household, and outside help when needed – mothers could prevent most of the deaths that occur in pregnancy, childbirth, and childhood.

The 10 decisions every mother must be free to make

If all mothers were free to make the following ten decisions, most of the negative events that sustain the high rates of poverty, inequality, sickness, and death in too many parts of the world could be prevented.

 1) Earning an income: If every mother earned and controlled her own money, almost every measure of human development would improve, including economic growth, poverty and inequality, health and education, and, in the long-run, even peace and security. Yet the proportion of women who are employed globally remains low at 43%, according to the World Bank, leaving an estimated 1.7 billion non-employed women in the world, most of whom are mothers.

2. Using contraception: If every woman could control if, when, and how many children she has, she could simultaneously improve her own health, education and employment, and invest more in her children. For example, if all women who wanted to use contraception could do so, deaths in pregnancy and childbirth and among newborns would fall by a massive 60%, according to the Guttmacher Institute. Yet currently an estimated 336 million women have an unmet need for modern contraception, including 228 million married/partnered women and 118 million single women. Further, 196,000 women still die in pregnancy and childbirth every year and 2.4 million babies die in the first month of life, according to the Global Burden of Disease (GBD).

3) Learning to read and write: The more educated a mother the more likely her children are to survive and thrive. An astonishing half of the reduction in child deaths in recent decades is the result of increases in the education of women of reproductive age, according to the Institute for Health Metrics and Evaluation, yet women still make up two-thirds of the world’s 770 million illiterate adults. Of special concern are the 10 countries where more 70% of adult women are illiterate, including Niger, Chad, Afghanistan, South Sudan, Mali, Benin, Guinea, the Central African Republic, Sierra Leone, Burkina Faso, Liberia, and Ethiopia, according to UNESCO.

4) Eating nutritious food: If every woman entered pregnancy with a well-nourished body, the risks of maternal and child death would fall. Yet women and children under five account for the majority of malnourished people in the world. Women are 52% of all underweight adults and 60% of all obese adults, according to the Lancet.

In India alone 42% of women enter pregnancy underweight, according to the Research Institute for Compassionate Economics. Although child stunting is falling, there are still 150 million children who suffer this form of chronic malnutrition, and 45 million children who are wasted, according to UNICEF.

5) Breastfeeding early and often: If all mothers were able to breastfeed their babies within an hour of birth and continued exclusively for six months, up to 800,000 child deaths could be prevented each year, according to the Lancet. Yet less than half of all newborns are breastfed within an hour of birth and for the first six months of life. Most mothers in the world still lack access to breast pumps at home and at work and find it very difficult to access donor human milk when they cannot breastfeed.

6) Practicing skin-to-skin care: Preterm birth is the second leading cause of death among children under five after pneumonia according to the GBD. Fifteen million babies are born too soon each year and 663,000 die each year. If mothers were able to keep their newborns close by, practicing so-called “kangaroo mother care,” many of these deaths could be prevented without the need of sophisticated medical technologies. Yet kangaroo mother care has not  been widely adopted and the practice of separating mothers from sick and vulnerable newborns remains widespread in many settings, according to WHO.

7) Vaccinating herself and her children: Vaccination is one of the most powerful tools at a mother’s disposal providing she has access to safe, affordable vaccines that target the greatest risks to her own and to her child’s survival. Yet still in too many countries, mothers do not have access to vaccines in pregnancy and their children do not get the pneumonia and diarrhea-fighting vaccines, which together offer protection against the leading infectious threats to children. 51% and 54% of the world’s children are still not receiving the pneumococcal and rotavirus vaccines respectively, according to WHO.

8) Educating herself and her children: The first three years of a child’s life are so critical for brain development that they influence later educational performance, job prospects, and lifetime earnings. Yet preschool education is rare for children born into low income families with less than 10% in many countries getting an early education, according to UNICEF. Education for parenting is rare everywhere, and contributes to the high rates of emotional and physical abuse in many homes.

9) Adopting new technologies: Technology is on the side of mothers everywhere. When families, schools, and governments have failed to educate girls and women, the mobile phone, the internet, the radio, and the television can step in. Yet, 200 million fewer women than men own mobile phones globally, according to GSMA, and 23% fewer women than men in low income countries have access to the internet, with gaps as high as 35% in South Asia and 43% in Sub-Saharan Africa, according to Intel.

10) Exercising public leadership: When mothers get political, either by joining local mothers groups or by running for office and everything in between, the health and development of women and children improve. Not only do mothers groups literally save lives, according to the Lancet, but female politicians are more likely to invest in solving the problems that matter most to mothers, according to the Poverty Action Lab. Yet there is a critical lack of mothers in the most powerful leadership positions across all societies.  In the USA alone, just 11% of the most influential leaders are also mothers in contrast to the 80% who are fathers, according to the Motherhood + Public Power Index.

Making it as easy as possible for mothers to make these ten decisions should be the mission of every institution with a stake in future generations – employers, governments, and the vast network of development agencies now aligned around the Sustainable Development Goals. Every potential investment by any one of these actors should be filtered through the lens of whether or not it removes the constraints that prevent mothers from taking these actions.

But even this is not enough

Where barriers are the steepest, mothers should be rewarded for making the right decisions with incentives that further enable them to raise healthy, educated children. Incentives could be anything from cash transfers and subsidized health and education services to business loans or transport subsidies.

The world’s 300 million mothers of children under five represent the single largest, most powerful, but as yet unleashed, force for development. By moving mothers to the top of the global development agenda we can enable them to make the decisions that are in their best interests and in the best interests of their children.

Updated September 2021