What is the scale of the problem?
The shocking toll of maternal mortality is hard to measure exactly, because so many women’s deaths go unreported. But the existing evidence is compelling:
- A poor woman in Ethiopia is 200 times more likely to die as a result of pregnancy and childbirth than a woman in the UK.
- Sierra Leone has the world’s highest maternal mortality rate – 1 in 50 women will die in childbirth.
- Each year, at least half a million women die from complications of pregnancy and childbirth. 99% live in the developing world.
- Another 10–20 million women suffer severe health problems each year because of complications.
What is being done to reduce maternal deaths?
The health of pregnant women and new mothers finally appears to be getting more international attention, but this is long overdue. The goal of cutting maternal deaths is the most off-track among the Millennium Development Goals. It presents a massive challenge for anyone concerned with improved health around the world.
Are there any examples of good progress?
Honduras cut its maternal mortality ratio by 38% between 1990 and 1997 through a package of measures including emergency obstetric care, family planning, a referral system for women with complications and an increase in the presence of skilled attendants at births. Nepal has also had dramatic reductions in maternal mortality. The mortality ratio was 40% lower for the period 1999-2005 compared to 1989-1995.
On a smaller scale, in Sierra Leone, evidence from a Health Poverty Action project showed that the maternal mortality rate at Kamakwie Hospital had gone down by 72%.
What are the key obstacles for women in developing countries?
Too often there are not enough trained health workers to serve remote communities. This makes it difficult for women to get care before, during and after giving birth.
Women may be put off by the cost of travel, or because they are unable to take time off from work or family duties.
Many women from indigenous communities are discouraged from using the health services that are available because staff do not understand their cultural practices or display prejudice.
Emergency obstetric care may not be available. Emergency care is particularly important in reducing maternal mortality. Three key factors are known as the ‘three delays’:
- the time it takes to decide whether to get help
- transport problems when going for help
- the lack of skilled staff, equipment and supplies, once a woman arrives at a health centre or hospital.
What other factors put women at risk during and after pregnancy?
The challenges are compounded for women living in poverty:
- Women need good nutrition before, during and after pregnancy – to avoid malnutrition and anaemia, for example.
- Women need clean water and sanitation to ensure good hygiene.
- Pregnancy can be especially risky for young girls, for older mothers, for those whose pregnancies are not spaced some time apart and for women with existing health problems. In all these cases lack of access to contraception and sexual health advice puts women at further risk.
- Many women have to continue heavy physical work throughout their pregnancy in order to earn a living or run a household.
What is fistula?
One particular maternal health problem is ‘fistula’. This is an injury to a woman’s birth canal that leaves her leaking urine or faeces. It is a particular problem for young women who have a prolonged and obstructed labour without access to medical help. Some practices of traditional birth attendants can also lead to fistula.
Fistula has lasting consequences for a woman’s dignity and social status if help is not sought. It often leads to her being ostracised by her husband, family and community.
What is Health Poverty Action doing to help?
- We train local government health staff and work with community midwives and traditional birth attendants to provide nutritional advice
- We improve immunisation coverage
- We increase the quality and frequency of outreach visits by local health staff to remote villages
- We improve emergency obstetric care and develop infrastructure
- We are training for health staff to provide life saving assistance to women during childbirth in Ethiopia
- In Somaliland Health Poverty Action also continues to broadcast the popular Saxan Saxo radio health education soap opera which promotes the improved maternity services now available.