Thanks to efforts initiated by the sixth Millennium Development Goal (MDG) to reduce maternal mortality worldwide by 75 percent, the maternal death rate has significantly decreased in East Asia and Latin America. In some of these countries, the rate has decreased by as much as 50 percent through cost-effective interventions.
However, in Africa and South Asia, pregnancy and childbirth complications are still the leading cause of death for women. 85 percent of maternal mortality occurs in sub-Saharan Africa and South Asia. The causes of death are hemorrhage, infections, anemia, unsafe abortions, and high blood pressure, leading to seizures and obstructed labor. The overwhelming number of maternal deaths in Africa and South Asia indicate inadequacies in their health care system, as well as a violation of women's fundamental rights to life and health.
“When a mother dies during pregnancy or child birth, her birth often reflects a failure of the health system. Strong health systems are able to deliver the care women need when they are ready to deliver,” the co-ordinator of the Maternal Health Thematic Fund's Reproductive Health Branch at the United Nations Population Fund (UNPF), Yves Bergevin, told MediaGlobal.
“Increasing financing of health systems is important in reducing maternal mortality. National health plans must be adequately funded so that quality reproductive health services can be scaled up to ensure universal access. This often requires a significant amount of leadership and governance to make sure that reproductive health is a strong component of the national health plan, adequate resources are allocated, and progress effectively monitored through the routine collection of quality data,” continued Bergevin.
Access to quality health facilities is an essential element in reducing maternal mortality. Bergevin underscored the need for one health centre for every 100,000 people to provide basic emergency obstetric care. A local health center would be able to prevent and manage hemorrhaging, a primary cause for maternal deaths, with the drug oxytocin. Additionally, Bergevin suggested one district hospital for every 500,000 people able to provide comprehensive emergency obstetric care. A district hospital would be able to perform a cesarean section and blood transfusion if needed.
“Safe deliveries happen when quality emergency obstetric care is available and financial, geographic, and socio-cultural barriers to accessing this care has been eliminated,” Bergevin suggested.
Studies by the World Health Organisation (WHO) have found a direct correlation between high maternal mortality and low numbers of skilled attendance at birth. This pervasive problem affects every high maternal mortality country. The WHO estimates the need of around one-third of a million midwives globally to reduce maternal mortality.
Skilled health workers attend 62 percent of births all over the world. Almost all births in developed countries are monitored compared to the 57 percent in less developed countries, and 34 percent in least developed countries.
Additionally, 35 percent of pregnant women in developing countries do not have contact with health personnel prior to giving birth, and 70 percent of women in sub-Saharan Africa do not have contact with personnel following childbirth.
“National capacity, and particularly institutional capacity, must be increased to ensure that more skilled birth attendants can be recruited, hired, trained and retained. Well-trained midwives can provide basic emergency obstetric care, identify serious complications and refer women to facilities for comprehensive emergency obstetric care, when necessary. In most countries with high maternal mortality, skilled attendance at birth is very low, particularly among poor women and women in isolated rural areas,” said Bergevin.
High maternal mortality rates are also attributed to a lack of family planning in the developing world. Family planning services include information and medical supplies that give women the freedom to decide if they want to have children and if so, the number and spacing of such children. Adequate family planning services include a choice of three or more forms of contraception and comprehensive information allowing the woman to make informed decisions.
“Many countries with high maternal mortality have a very high unmet need for family planning, particularly among adolescents. This unmet need leads to high numbers of unwanted pregnancies. With each pregnancy a woman's chance of dying increases. Meeting the unmet need for family planning will contribute to a reduction in the number of maternal deaths,” explained Bergevin.
Equally important to the provision of contraception, is the empowerment of women to understand reproductive health and their rights. Ensuring universal access to information and resources to plan the number and spacing of children empowers women to use such resources, decreasing the number of unwanted pregnancies and ultimately, the number of maternal deaths.
However, to increase the supply of quality family planning is only effective when there is a demand within a community. Women must understand their right to family planning and have the financial, geographic, and sociocultural means to access and use it regularly.
Article published courtesy of MediaGlobal.
