Its 11:11, make a wish.
It’s a moment that comes twice a day. What is your wish?
This Mother’s Day, our wish at Go-MCH is for an equitable world where all women have the chance of surviving childbirth through ongoing access to prenatal and maternity care and a delivery with a health care professional.
Every year, 360,000 women who are giving birth, die in the process. No woman should die while giving life.
Source: WHO, Systematic Review of Causes of Maternal Death (preliminary data), 2010
Maternal Mortality is a multi-faceted issue related to social, economic, and cultural issues spanning from the quality of health care available in a nation, to the health and nutritional status of the mother, to whether she can be allowed to leave the house on her own to seek health care. Ultimately, a systems approach is the only way maternal deaths will truly be reduced and ensure that interventions are not only saving a life, but saving the lives of women to enable them thrive to support their families and their communities long term.
When a mother dies:
The probability of survival to age 10 years was 24% in children whose mothers died before their tenth birthday, compared with 89% in those whose mothers remained alive. The greatest effect was noted in children aged 2—5 months whose mothers had died. The effect of the father’s death on cumulative probability of survival of the child up to 10 years of age was not as obvious. Age-specific death rates did not differ in children whose fathers died compared with children whose fathers were alive. (The Lancet, Volume 375, Issue 9730, Pages 2024 – 2031, 5 June 2010)
Why are women dying?
Access to Health Care Workers during Childbirth
- There is a mass demand for access to health care workers in low income nations. For example, For every 100,000 women who give birth Tanzania, almost 800 die (compared to 24 in USA ). Almost all of these deaths could be prevented if women had access to skilled health workers.
- Yet there is a dire shortage of health workers with midwifery skills in rural Africa and Asia. In Tanzania, and half of women still give birth with no one to help them except neighbors or relatives. It is estimated that of the 1000 women and 8500 babies who die every day around the world, a third could be saved if they had access to skilled health care. (Huffington Post, White Ribbon Alliance: http://www.huffingtonpost.com/mobileweb/rose-mlay/international-midwives-day_b_1480842.html)
Access to Clinical care:
- A woman can die of post partum hemorrhage within 24 minutes. The probability of a woman accessing life saving drugs to stop post-partum hemorage in a low resource region are very small, as clinics and access to medical care are hours and even days away. Women who can plan ahead, or have access to resources are lucky, but that is often not the case in high need areas of Asia, Africa, and Latin America. Skilled health care workers are at a dire low. According to the White Ribbon Alliance, only 63% of women deliver with a skilled health professional. In the poorest, least developed countries the situation is even worse with only a third receiving skilled care.
- Ongoing research over the last ten years has concluded that both oxytocin and misoprostol are the best treatments, as a prophylactic and during PPH, to ensure a woman does not bleed to death during or right after childbirth.
Poverty
- Education and economic status vastly improves a woman’s probability of accessing health care, being strong enough in their own health and nutritional status, to survive childbirth, in any country. Globally, women and girls make up 60% of the world’s poorest people and two-thirds of the world’s illiterate people. Yet, with education and empowerment, they can lead healthy lives, lift themselves and their families out of poverty and disease, usually marry later, and have fewer and healthier children.” (Lancet: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2960905-1/fulltext)
Nutrition
- A woman who is malnourished is likely to be anemic, vitamin A deficient, and too weak to sustain a healthy childbirth, especially in an area without proper medical care, clinical resources, and trained health workers. Additionally, the fetus would have been taking all the necessary calcium and other vital nutrients during gestation and therefore her nutritional status would be drained due to internal and external factors.
- According to an article in the American Journal for Clinical Nutrition, The risk of death is greatly increased with severe anemia (Hb <70 or 80 g/L). Current programs of universal iron supplementation are unlikely to have much effect on severe anemia. There is an urgent need to reassess how to approach anemia control in pregnant women. Obstructed labor is far more common in short women as well- which is attributed to those women who have been stunted due to severe malnutrition within the first five years of life. (http://www.ajcn.org/content/72/1/212S.full)
- “Girls more so than boys become severely malnourished and that the cause of maternal death often has its roots in a woman’s life before pregnancy—during infancy or even before her birth—when deficiencies of calcium, vitamin D, or iron begin. Malnutrition may result in chronic iron deficiency anemia and death from hemorrhage, and referred to maternal depletion from pregnancies spaced too closely together. “ Malnutrition and maternal mortality is a cyclical problem that is passed on from mother to child and dependent on social, educational, and economic factors.
Around the World
North-South Korea Maternal Health Project:
- Paediatric and Maternity hospitals have been renovated and supplied with medicines and laboratory equipment, WHO said in a statement. “It is an extremely cost-effective measure that gets a high rate of return in terms of incidence of disease, in terms of reduction of mortality, and so on”, Eric Laroche, assistant director-general for health action in crises at WHO said. “Along with that there were strategies to reduce the ill health of mothers and to reduce maternal mortality with emergency obstetric care.” WHO statistics support his upbeat appraisal. The number of operations undertaken has increased 8% since 2006, while postoperative infection rates have fallen by more than 42%. Over the same period, North Korea has trained more than 6000 health professionals in emergency obstetric care, newborn care, and the management of childhood illnesses. The project is in place in 80 of North Korea’s 220 counties, and there are plans to take it to other parts of the country over the coming years. (The Lancet, Volume 375, Issue 9730, Page 1953, 5 June 2010)
Bolivia’s Maternal Health Project:
- Bolivia’s health ministry hopes the initiative, which is a signature policy of the leftist government of Evo Morales and a declared state priority, will reduce maternal mortality rates by roughly half by 2015. With 290 maternal deaths per 100 000 livebirths in 2009, according to government data, Bolivia has one of the highest rates in the Americas. Since 2009, hundreds of thousands of women and children have benefited from the initiative but an array of teething problems, logistical bottlenecks, and a lack of resources continue to mar its progress and prevent its widespread implementation. (The Lancet, Volume 375, Issue 9730, Page 1955, 5 June 2010)
- The conditional cash transfer programme known as the Juana Azurduy stipend, offers cash payments totalling US$260 to pregnant women paid in instalments on condition they attend regular prenatal and postnatal check ups until their child is 2 years, and have a skilled attendant present during birth. (The Lancet, Volume 375, Issue 9730, Page 1955, 5 June 2010)
Pakistan
- “In a decade, the number of annual deliveries has increased from 6000 to 16 000. Services are due to expand to include a separate obstetric fistula repair centre, as well as a learning resource centre. The department has already trained hundreds of obstetricians and gynaecologists, now “serving the women of Pakistan”, including those in remote rural areas and deprived districts, says Shereen Bhutta. Another successful project that Shereen Bhutta oversees is the Pakistan Society of Obstetricians and Gynaecologists’ collaboration with the International Federation for Gynecology and Obstetrics in rural Sindh province. After 4 years, implementation of the first emergency obstetric and newborn care services in the area has been challenging. “But the effort was worth it because it has contributed to reduction of maternal and perinatal mortality”. She adds that the community is now the strongest advocate of the services.” (The Lancet, Volume 375, Issue 9730, Page 1962, 5 June 2010)
This Mother’s Day in the United States… our wish is for all mothers to be remembered. Please view the public service announcement, by our partner Every Mother Counts (www.everymothercounts.org) :
Image Source: USAID Saving Lives at Birth
The Global Organization for Maternal & Child Health Blog 