Maternal Mortality: A Report on Investing in Girls and Women

By: Winnie Yu Scherer, originally printed in the report by Media Planet, Investing in Women and Girls

Every year, as many as 500,000 girls and women around the world die from pregnancy-related causes. Between 10 and 15 million women suffer severe or lasting illnesses or disabilities caused by complications during pregnancy and childbirth.

In 2000, the United Nations set out to change the plight of these women through its Millennium Development Goals, an international effort to combat extreme poverty. A key Millennium goal is to reduce maternal mortality by three-fourths by 2015 and provide universal access to reproductive health care services.

Reaching this goal, however, has been slow, despite its great importance, says Jill Sheffield, president and CEO of Women Deliver, a global advocacy organization dedicated to improving maternal health.

The ability to plan

Critical to the prevention of maternal mortality are family planning services, Sheffield says. Every year in developing countries, there are 215 million women who want to avoid pregnancy, but either aren’t practicing contraception or are not using an effective method.

“If we could get modern contraception to those women who lack access to family planning, we could lower the number of unintended pregnancies by more than twothirds, prevent more than 70 percent of maternal deaths, and reduce the number of unsafe abortions,” she says.

Access to skilled care

Protecting maternal health must also involve providing skilled obstetrical care. Many women in developing countries rely on relatives or other village women with no formal medical training to deliver their babies. Sheffield says approximately 40 percent of all pregnancies involve a complication, and in 15 percent those complications will be life-threatening.

"The number of women in developing countries who are dying while pregnant or giving birth is unacceptably high,” says Richard Waldman, MD, president of The
American Congress of Obstetricians and Gynecologists. “Most maternal deaths can be prevented, and yet women continue to die needlessly. We must make a commitment to get these important services and adequate resources to the women who need them most.” Many women in developing countries never see a doctor during pregnancy, says Herbert Peterson, MD, professor and chairman of the Department of Maternal and Child Health at the University of North Carolina in Chapel
Hill.

Ideally, all pregnant women should have access to prenatal care, skilled care at birth, and immediate postnatal care for both mother and baby. “Prenatal care is an important component of the solution,” Peterson says. “Most of the benefit can be included in as few as four visits.” Women also need access to safe abortions, Sheffield says. According to the U.N., an estimated 68,000 women die every year from unsafe abortions, and millions more suffer long-term disability. Abortions
should be done by trained health care providers in sanitary conditions and followed up with proper care that includes family planning counseling.

“We know what to do to prevent maternal deaths, but we need to understand better how best to do it in the low resource settings where most of these deaths now
occur. Then we need to make sure we translate that knowledge into action,” Peterson says.

Planning and Good Care

Providing access to contraception has an enormous ripple effect, according to a report by the Guttmacher Institute and the United Nations Population Fund. Consider this:

• The world currently invests $3.1 billion in contraceptives services, which enables 603 million women to prevent 188 million unintended pregnancies each year.
• Preventing these pregnancies results in 112 million fewer abortions every year and 54 million fewer unplanned births.
• Providing contraceptives saves 200,000 mothers from dying of pregnancy-related causes, and spares the lives of more than a million newborns.

“Family planning programs are arguably among the most successful public health interventions of the last century,” says Paul Blumenthal, MD, MPH, director of the Stanford Program for International Reproductive Education and Services. “By helping women avoid unintended, unplanned, or unwanted pregnancies, the maternal  mortality associated with such pregnancies can be prevented.”

While most cases of maternal mortality occur in developing countries, the US is not unscathed. According to The American Congress of Obstetricians and Gynecologists (ACOG), the US rate is one of the highest in the developed world. “One woman who dies during pregnancy or in childbirth is one too many,” says Richard Waldman, ACOG President.

Most disturbing, Waldman says, is the racial gap. Among African-American women, there are 34.8 deaths for every 100,000 live births, compared with 10.2 for Hispanic women and 9.1 for white women. ACOG has the ability and a responsibility to play a strong role in guiding maternity care, says Waldman.