Frederick Torgbor Sai

Frederick Torgbor Sai is known by many as the “grandfather of maternal health”. He has received many awards for his efforts, including the 1993 United Nations Population Award, and in 2006, one of his nation’s highest honors, the Member of the Star of Ghana. Dr. Sai served as the chairman of the National Population Council of Ghana from 1992-1997. He was the president of International Planned Parenthood Federation and also a senior population advisor at the World Bank from 1985-1990. His most recent book is With Heart and Voice: Fred Sai Remembers, a vivid account of his childhood and experiences in the world of reproductive health.

I am often asked why, as a man, I have been so involved and persistent in this field, a field that is often tied to “women’s issues.” My primary response is simple: I care because it is the right, humane, and human thing to do. This is what drives me. Also, I happen to have lived through some of the horrific circumstances that can surround the issue of family planning and reproductive rights.

I believe that the success of African leadership in this decade shouldbe judged first and foremost by the progress made in the lives of our girls and women.

My father died when I was very young – three or four years old. I was brought up mainly by my mother, and therefore I had to stay in the women’s compound in Osu, where I grew up, a lot longer than ordinary boys of my clan. I stayed there until I was about ten years old. So as a young, impressionable child, I was surrounded, always, by girls and my powerful aunties, and my mother.

Then a bit later, I worked in my first job as a stand-in teacher to a class of thirty girls, in Osu, and I learned even more about girls. It was during this time that I was waiting anxiously for the results of my Cambridge School Certificate exams, which had been delayed by World War ll. Finally, I left my country at age 23, in 1947, and went overseas, having received by good fortune a British Colonial Government scholarship. I trained in medicine at the University of London, and in Edinburgh. In Britain in the 1940s and 1950s, not even the condom was available very readily. I saw the result of this restriction. There were girls, overseas students like us, who had gotten pregnant and could not face it and had gone to unskilled providers. A couple of them had died, and one had attempted suicide.

When I returned to Ghana as a doctor, one of my assignments was to conduct autopsies or post mortems and I was to see horrible things on those slabs as a result of botched abortions.

Early on, I was doing research for a paper I had to write and I began to read about nutrition. I read about the malnutrition levels in Africa, and I became engaged in this problem. Later, in the 1960s, when I was called on to help develop the family planning program in my country, I didn’t hesitate to join. It was around this time that I made the connection between nutrition and family planning. I was looking after these children who had “kwashiorkor,” as we call it, which is protein-energy malnutrition. Scientific papers had reported that quite a large proportion of the children found with this condition had mothers who’d had children very close together. So we began to advise people on how to space their children better.

Women are dying in childbirth by the hundreds – not because the technology for saving them is not available, but because the will, the support, the enthusiasm, the understanding that this is the humane thing to do, the human thing to do, is not there. When you see women dying from preventable and manageable causes, you must do something.

Worldwide, there is good news. A study in the Lancet from March 2010 found that the number of women who die every year in childbirth is dropping at an unprecedented rate. From 1980 to 2008, maternal deaths globally have fallen from 500,000 each year to 340,000.

The latest news from the United Nations is that the number of maternal deaths globally is now below 300,000, continuing the decline. Having spent some forty years working on women and children’s health in Ghana and across Africa, I welcomed this progress when I heard this news.

But as the world celebrated, I also couldn’t help but wonder, “Where is Africa?” I am saddened and even ashamed at the poor progress my continent has made in maternal health.

It is an unfortunate truth that progress for the world at large does not necessarily mean progress for Africa. Maternal mortality in Africa is complex, and challenging. Our countries face increasing rates of HIV, entrenched and debilitating poverty, food shortages, weak education and health care systems, problematic governance, corruption, and civil conflict. These are huge issues in their own right, but they also have significant impact on maternal, newborn, and child health.

It doesn’t need to be like this. I am confident that we can address this crisis if we shift our approach and start investing in women. We must increase women’s access to health services. We must promote business development and support women with grants and loans. We must ensure that girls have access to quality education. And we must work to convince our neighbors, be they relatives or countries, to prioritize women and girls in all that they do.

Reducing maternal deaths is not a simple battle, and the high ratios of maternal death in African countries will continue to shame and burn me until we see progress across the continent. I do, however, rest a little bit easier seeing some momentum around this issue. And I hope that when the next round of statistics are released, the story is about African progress – progress that was spearheaded by Africans.

Many African leaders understand the urgency of addressing the maternal health crisis, despite its complexity. They have a sister, a niece, or a daughter who has died – or if they do not, they certainly understand the broader impact maternal death has on their countries. Women are the heart of African economies. They transport two-thirds of all goods that are moved and produce 60-80 percent of the food in the developing world. And maternal and infant deaths account for $15 billion in lost productivity.

I believe that the success of African leadership in this decade should be judged first and foremost by the progress made in the lives of our girls and women. My credo is there should be no more unplanned pregnancies in Africa. There should be no more unsafe abortions in Africa. There should be no more preventable childbirth-related deaths in Africa.

It is because of all of this that I remain in this field. Many people ask me, how is it that you have lived so long and you continue still to advocate these things with such passion?

I tell them that I think I’m afraid that when I die, I will be judged by how I have failed – what I was unable to do. And so I persevere.

I am happy to see progress being made when I am alive. I am old, but I still have a voice. To the extent that my little heart will keep ticking and supporting that voice, my voice and heart are with this cause.