Improving Maternal Health


08/18/2005


UN Millennium Development Goal #5

Childbirth remains an unnecessarily dangerous and life-threatening risk for women throughout the developing world. Every year, twelve million women are permanently disabled and between 500,000 and 600,000 die from treatable complications during childbirth because of lack of access to proper pre-and post-natal care – accounting for nearly 1,600 maternal deaths per day. Ninety-nine percent of all maternal deaths occur in developing countries – specifically in Asia and sub-Saharan Africa where poverty is most prevalent. One in every sixteen women in sub-Saharan Africa dies of pregnancy-related causes; in the developed world, only one woman in every 2,800 is at risk of maternal death. Almost all of the women who die in developing countries during childbirth would still be alive if they had pre- and post-natal care, access to a skilled midwife or doctor in childbirth and effective emergency care for obstetric emergencies. Additionally, improved access to contraceptives could further help in reducing maternal mortality by allowing women to plan their families

As contraceptives are often difficult to get reliably in developing countries, many women are unable to time or space their births leading to large families and children born close together, which can weaken women’s health. Lack of contraceptives and sexual education also leads to unwanted pregnancies which can further deter women from spending scare resources on pre-natal care. Delaying marriage and the birth of a first child, preventing unwanted pregnancies and eliminating unsafe abortions would cut the number of maternal deaths by up to a third. Abortion is illegal in most developing countries and for the thousands of pregnant women every year without access to legal and safe abortion, abortion can result in death. Globally every year, 80 million women face an unwanted or unplanned pregnancy and 20 million women risk having an unsafe abortion rather than carry their pregnancy to term.

Many women in developing countries have very little access to pre- or post-natal care which puts them further at risk for complications during their pregnancy. Women in developing countries often lack the economic resources and education to make informed decisions about their health and nutrition. Some women are denied or lack access to services because of logistical, social or cultural barriers. Combined with excessive physical labor and poor nutrition, this lack of prenatal care increases the risk of maternal mortality. Additional factors that prevent women in developing countries from receiving the life-saving health care they need include distance from health services, costs, poor quality of available services and substandard treatment by health providers.

Gender-based violence also greatly contributes to maternal mortality. Women who suffer from domestic violence in pregnancy are more likely to miscarry which can cause complications. Female genital circumcision which is prevalent in some developing countries can also complicate childbirth. The disparity in women’s health among rich and poor countries is becoming increasingly pronounced. Recognizing the poor condition of women’s health globally and the devastating reality of maternal morbidity and mortality, UNICEF has characterized it as “in scale and severity the most neglected tragedy of our times.”


The Fifth Goal

The fifth goal of the UN Millennium Challenge is thus to improve maternal health.

To Improve Maternal Health


Target: Reduce by Three-Quarters, Between 1990 and 2015, the Maternal Mortality Ratio


The repercussions from high maternal mortality rates echo throughout the developing world. Each year, three million babies die within their first week of life. Improved maternal health could prevent up to 70% of these neonatal deaths. Up to two million children every year are orphaned because their mother has died as a result of complications in pregnancy or childbirth. Only Latin America and the Caribbean are on track to meet the international target of having 90% of births attended by a skilled health worker by 2015. Asia has only made limited progress and in Sub-Saharan Africa, the rate has remained the same since 1990. Without more action at the national and international level, the target won’t be met. To achieve the targeted measure of improving women's health and reducing the maternal mortality ratio by three-quarters, the UN Taskforce on Child and Maternal Health has outlined a broad range of reforms and interventions.

In order to allow couples to plan their families, sexual and reproductive health education and communication skills must be made available to all men and women. Quality contraceptives must also be readily available alongside this education. Having a strong primary healthcare system which can be accessed and used by everyone, particularly poor and under-served women, is a prerequisite for many of the actions needed to improve maternal health. Healthcare facilities staffed with trained birth attendants can ensure easier access to basic pre- and post-natal care for all women. Beyond treating complications and attending the birth, trained birth attendants are often the only source of comprehensive reproductive and physical health information – a vital lifeline inaccessible to millions of women throughout the world. Alongside improved access to health care facilities, access to skilled birth attendants or health workers trained in midwifery greatly improve a woman’s chances of surviving childbirth. Many women’s lives are lost because of delays during the childbirth. Without improvements in gender equity within domestic healthcare systems, reductions in maternal mortality and the general improvement of women's health will not be possible.

The Displaced and Stateless Populations

Displaced and stateless mothers are disproportionately impacted by maternal morbidity and mortality. Lack of access to basic health care has caused displaced people to have some of the highest rates of infant and maternal mortality in the world. For displaced women, lack of quality reproductive health services can also lead to increase in the spread of sexually transmitted infections, including HIV/AIDS, an increase in unsafe abortions and increased morbidity related to high fertility rates and poor birth spacing.

In addition to receiving inadequate reproductive health care, displaced women are more vulnerable to sexual violence by armed forces and others and face exploitation in the absence of traditional socio-cultural constraints. Without access to emergency contraception, displaced women who have been raped often find themselves pregnant with an unwanted child. Displaced women fleeing conflict also lack access to safe childbirth and emergency obstetric care.

Displaced women are often unable to access humanitarian assistance and healthcare due to the extremely dangerous security conditions that caused the displacement in the first place. Displaced camps are often inaccessible because of infrastructure problems as well as insecurity and this can prevent humanitarian workers from delivering needed healthcare. Reproductive and maternal health is often seen as “non-essential” humanitarian assistance and under-funded. When displaced people live outside camps, they are often unable to access healthcare from international humanitarian assistance efforts. Displaced women cannot rely on host communities where they seek refuge to provide assistance as these communities often reside in under-developed areas and are rarely able to provide adequate health services to their own people. A sudden influx of refugees or an internally displaced population can overburden even the most basic services of the local health system. Although refugee camps provide a measure of assistance to displaced populations, internally displaced women often lack even the modicum of protection and assistance provided refugee mothers.

Stateless women, lacking citizenship and nationality, are often unable to access even basic services of the state such as government health clinics, putting them further at risk. As many stateless live in poverty and lack the economic opportunities offered to others, they are unlikely to be able to use many private clinics that charge user fees, making them more likely to resort to unattended births. Stateless women are also less protected by any government laws regarding age of marriage because they are unlikely to have documents for birth registration.

Therefore, Refugees International recommends that


Beyond expanding and improving the quality and coverage of primary health systems in areas where internally displaced and stateless populations reside, governments of developing countries and international donors increase investments in public health in general to provide basic pre-and post-natal healthcare for women;
In order to increase the access to state-run health facilities, governments remove or lower user fees for primary healthcare to increase access for displaced or stateless women;
Donors and governments work to increase the number and quality of skilled birth attendants and health workers trained in midwifery in developing countries;
Donors support governments in incorporating family planning and comprehensive sexual and reproductive health education, including information on contraception and abortion, into education curriculums to delay early marriage and childbearing and prevent and manage unwanted pregnancies;
The U.S. Congress remove restrictions for funding the United Nations Population Fund, the world’s leading provider of family planning and maternal health in developing countries;
The U.S. government immediately repeal the “Mexico City Policy,” an executive order imposing restrictions on U. S. funding for international family planning and prohibiting nongovernmental organizations outside the United States from receiving funding if, with their own funds and in accordance with the laws of their countries, they “performed” or “actively promote[d] abortion as a method of family planning.” This policy has the effect of limiting the ability of international and local health care providers in developing countries from providing full reproductive health care services to their patients.
Donors, international humanitarian organizations and local NGOs increase maternal health, nutrition and reproductive programming in refugee and displacement camps, communities hosting displaced populations, as well as within vulnerable and under-served stateless populations;
Governments and international agencies augment security and protection services and humanitarian assistance to refugee, displaced and stateless women in order to minimize deaths associated with conflict, rape and gender-based violence, and HIV/AIDS.