Maternal deaths drop, but progress is slow

Hawa, a 21-year-old woman, had been in labour for three days before she was finally referred to the hospital in Jowhar, 18 kilometres from her village, in Somalia. She was examined by medical staff and diagnosed with obstructed labour and foetal distress.

Much time was wasted in getting the consent of her relatives, and doctors performed a caesarean and a distressed baby boy was delivered, needing resuscitation. Fortunately, Hawa and her baby survived the entire ordeal, according to a report – Maternal Death: The Avoidable Crisis – released by Médecins Sans Frontières (MSF) or Doctors without Borders, on March 9.

Binta, 16, was brought to Jahun General Hospital in Nigeria after trying to deliver for two days at home. Her labour was obstructed, but doctors were able to do a vacuum delivery and Binta safely gave birth to her first child. “I was so tired from being in labour for so long that I couldn’t push anymore. If I had not been able to come to the hospital, I would have suffered and the end result would have been death for both me and my baby,” Binta told MSF.

These are two instances of the ordeals women experience, particularly in developing countries, where they face the threat of maternal deaths which experts consider “preventable”.

Afghan mothers at risk

“About 15 per cent of all pregnancies worldwide will experience a life-threatening complication,” Catrin Schulte-Hillen, a midwife who leads MSF’s Sexual and Reproductive Health International Working Group – the organisation which provides emergency obstetric care in approximately 30 countries, including Somalia and Nigeria – told Al Jazeera.

Slow progress

While more than 340,000 women still die annually in childbirth –  the situation is slowly improving. Since 1990, some countries in Asia and Northern Africa have more than halved maternal mortality (in 1990, it was 546,000, while in 2008, it was 358,000), according to WHO figures. There has also been progress in sub-Saharan Africa.

Unlike in the developed world where a woman’s life time risk of dying during or following pregnancy is 1 in 4300, the risk of maternal death in developing countries is still high at 1 in 31.

Globally, the average annual percentage decline in the maternal death rate between 1990 and 2008 is only 2.3 per cent, according to The Millennium Development Goals Report 2010, released by the United Nations.

One of the United Nations’ Millennium Development Goals (MDG5) is to reduce maternal mortality by 75 per cent between 1990 and 2015. If the situation continues at its current rate, the world will not meet the Millennium Goals.

“Ninety nine per cent of these deaths are preventable,” Pamela W Barnes, President and CEO, of EngenderHealth, an advocacy group, told Al Jazeera. “Although there has been some progress in reducing maternal deaths over the past two decades, I believe there is so much more to be done. We know what the solutions are to prevent maternal death – in fact, some include simple and low-cost interventions, including family planning.” 

The problem, however, is not limited to developing countries. The report – Maternity Consumer Survey 2011 – released in New Zealand last week revealed that the quality of maternity care in New Zealand shows one in six mothers are dissatisfied with the overall care they receive during pregnancy.

The complications that may occur during the pregnancy cannot be always predicted. Typical and deadly complications, including hemorrhaging (24 per cent), sepsis or infection (15 per cent), unsafe abortions (13 per cent), eclampsia or hypertension (12 per cent) and obstructed labour (8 per cent), account for nearly three quarters of all maternal deaths worldwide, according to MSF. Targeting these killers is the most effective way to improve outcomes, experts say.

“Too often, maternal mortality is accepted as an unfortunate reality. The lack of attention to, or disregard for, women’s rights – in particular their rights to life, health, equality and non-discrimination – has led to policies, laws, services and infrastructure needed to eliminate maternal mortality being far too weak and in some cases non-existent,” Louise Finer, international advocacy manager for the Center for Reproductive Rights, told Al Jazeera.

‘Accessibility and acceptability’

In some developing countries, doctors and midwives have trouble getting consent of the patient to conduct operation in emergency. Women in labour will not be in the position to give consent and often time is wasted in waiting for the consent of either husbands or relatives.

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“The population should understand that we don’t have any hidden agenda. We know we can help them. They have to accept us, trust us that we are there to help them. We need ‘accessibility’ and ‘acceptability’,” Schulte-Hillen, from MSF, told Al Jazeera.

Attaining zero maternal death would require greater community involvement and commitment. “We have seen a decline in maternal deaths through the collective efforts of many organisations,” Jill Sheffield, President and Founder of Women Deliver told Al Jazeera.

Women in developing countries lack access to modern contraceptives – an estimated 215 million women want to either delay a pregnancy, or do not want any more children, according to a 2011 report from the UN Population Fund.

“Two hundred and fifteen million women have little control to prevent a pregnancy. And the needs are growing: the largest generation in history is entering its reproductive years – more than one billion young people. And family planning – low-cost intervention – could reduce maternal deaths by 30 per cent, simply by delaying pregnancy,” said Barnes.

Access to skilled birthing professionals is considered another key issue. Many developing countries suffer from “brain drain” of medical staff.  In Ghana and Malawi “more than a quarter of doctors and nurses have migrated, usually to the United States or to Europe”, Barnes said. 

Women Deliver is convening a conference in Kuala Lumpur in May 2013 to generate attention for maternal and reproductive health. The conference is anticipated to draw thousands of advocates, policymakers and researchers from around the world.

“Now is the time for us to prioritise girls and women. It is a good investment – and a smart one,” Sheffield said. “We have seen time and time again that when we invest in girls and women – it pays.”