Testing the “organized hypocrisy” hypothesis: the mixed effects of the World Bank’s Safe Motherhood investments on maternal mortality in sub-Saharan Africa

Holly E. Reed, CUNY Institute for Demographic Research (CIDR)
John Shandra, Stony Brook University, State University of New York (SUNY)

Despite the nearly 30-year old global Safe Motherhood Initiative, maternal mortality remains quite high, especially in sub-Saharan Africa. There have been important reductions in maternal mortality ratios (MMRs), but although much is known about how to prevent maternal deaths, MMRs remain stubbornly high in most sub-Saharan African nations. The World Bank is major funder of Safe Motherhood investments in the region, but the Bank’s financing methods for these programs are loans coupled with structural adjustment programs, rather than grants or loans with no strings attached. We examine the impact of World Bank Safe Motherhood programs and structural adjustment loans on maternal mortality in 33 sub-Saharan African countries between 1995 and 2005 using two-way fixed effects models. We find that although Safe Motherhood loans are associated with reduced maternal mortality, there is an opposite effect for structural adjustment policies; this “organized hypocrisy” may be eroding any gains in maternal mortality.