The Issue

Up to 15 percent of all women who give birth suffer life-threatening complications that, in most cases, can be treated with emergency obstetric care. Central to the efforts to reduce maternal mortality worldwide is making emergency obstetric care available to all women.

The five major causes of maternal mortality—hemorrhage (severe blood loss), sepsis (infection), unsafe abortion, hypertensive disorders (pregnancy complications associated with high blood pressure, including preeclampsia and eclampsia), and obstructed labor—are all treatable if the woman has access to trained healthcare workers at a well-equipped health facility.

What this means is that no woman should be denied access to appropriate and well-functioning health facilities. Whether it is a mobile health unit or a district hospital, we need to continue to work diligently to address barriers that prevent women from getting the emergency care they need—from a lack of income and transportation to a lack of trained health workers (such as skilled birth attendants and doctors) and hospitals.

The United Nations Population Fund (UNFPA) has identified five basic emergency obstetric and newborn care capabilities that can be provided in large or small health centers and that are necessary to protect mothers against preventable death:

1. The administration of antibiotics, oxytocics (drugs that produce uterine contractions and can treat hemorrhage) and anticonvulsants (used to treat eclampsia and preeclampsia)
2. Manual removal of the placenta following birth
3. Removal of retained tissue following miscarriage or abortion
4. Assisted vaginal delivery
5. Newborn care

Comprehensive essential obstetric care, usually provided by hospitals, requires the five components of basic obstetric care listed above, plus the capacity to perform caesarean sections, blood transfusions and provide resuscitation and care for newborns born premature, sick or at a low birth weight.

For every 500,000 people, there should be four facilities offering basic care and one facility offering comprehensive essential obstetric care. Furthermore, for every facility, there should be at least two skilled attendants on staff 24 hours a day, seven days a week, assisted by trained staff and with a functional operating theater. Unfortunately, for so many women, this is not the reality, especially in our world’s poorest countries.

In the most resource-poor countries, maternal mortality has been attributed to what is called the three delays. These are:

1. The delay in deciding to seek care
2. The delay in reaching care in time
3. The delay in receiving adequate treatment

The first delay is generally due in part to the mother; the family; an unskilled birth attendant; the community not recognizing a potentially life-threatening condition; not having the money to pay for care; social or cultural barries including fear of going to a hospital; or males having the decision-making power.

The second delay can be due to a lack of transportation, the remoteness of a mother’s location, or poor infrastructure, such as bad road conditions.

The third delay occurs at the health care facility due to inefficient or inadequate care, such as the facility’s lack of supplies, appropriate staff, or the inability to provide critical care for hemorrhaging, infection or other emergency conditions.

Links:

• Emergency Obstetric Care Factsheet
• Obstetric and Delivery Care Resources
• Monitoring Emergency Obstetric Care

Maternal health is a human right. Crucial to preventing avoidable maternal deaths and injuries is quality maternal health care that is accessible to all women. The world’s leading non-governmental organizations (NGOs) have determined a key set of care-related factors that continue to contribute to the large number of women dying during pregnancy and childbirth:

1. Lack of health workers. Half of the world’s women give birth at home alone or with only a friend or relative to help. Skilled attendance at all births is considered to be the single most critical intervention for ensuring safe motherhood. Up to 15 percent of all births are complicated by a potentially fatal condition and yet almost all are treatable when there is a skilled attendant present to recognize problems early and to intervene and manage the complication.
2. Lack of equipment and supplies. Even when a woman does get to a health center, there may be no trained staff, no drugs, no blood bank, nor the necessary surgical equipment and skills to perform a caesarean section.
3. Transportation. Rural women are far less likely than their urban counterparts to receive skilled care during childbirth. In rural areas, health clinics and hospitals are often spread out over vast distances and transportation systems are often rudimentary. It can take all day or night for a woman to walk to a health center, and even more time for her to get to a referral hospital for emergency care. A woman can bleed to death in two hours, and such delays cost many women and newborns their lives.
4. Funds. A lack of money means that many women can’t buy the simple things needed for their care, let alone pay the fees often charged by clinics and health workers.
5. In countries such as China, Cuba, Egypt, Jamaica, Malaysia, Sri Lanka, Thailand and Tunisia, significant declines in maternal mortality have been achieved through a combination of simple, yet critical interventions: access to family planning, skilled birth attendance and backup emergency obstetric care.

Links:

• Impatient Optimists: Mother, Child Health
• Safe Childbirth Checklist
• Saving Women’s Lives: The Skilled Care Initiative
• Focused Antenatal Care

Women face a higher risk of dying in childbirth in countries where the cost of health care falls heavily on patients (as is the case in Sierra Leone, which has the world’s worst lifetime maternal risks of death). Many women do not use health services during pregnancy and childbirth because their families simply cannot afford the costs. Improving the health care system overall is undoubtedly a critical component to reducing maternal mortality and improving the general health of a nation. We have identified the barriers and we know what it takes to prevent maternal mortality, but we continue to need strong leadership, policies and political will that will commit to and deliver the necessary resources for women to have safe pregnancies.

However, accurately measuring the progress that nations make and evaluating programs is an unexpected challenge. Two-thirds of nations do not have the capacity to collect data, and data collection varies from country to country in both quantity and quality. In addition, methodologies and measurement challenges differ from community to community. Despite these challenges, the movement to end maternal mortality should not detract from the urgent actions required to address this global human rights issue.

Together, we need to develop more effective constituencies to push maternal mortality to the top of our national and international development agendas; we need to engage, support and coordinate the efforts of policymakers and other leaders to reduce maternal death rates; and we need to empower communities to advocate for their right to care and demand more supportive and effective health care systems.

Links:

• Focus on Five: Women’s Health and the MDGs
• Consensus for Maternal, Newborn and Child Health

Caring for the health of women and their babies is essential, yet family planning and reproductive health services fall short of needs in developing countries. In these countries, maternal mortality rates are particularly high for young and poor women—those who have the most limited access to family planning information and services.

It is estimated than 175,000 women each year could be saved—and many more could avoid severe or long-lasting injuries—if they had access to contraception.

Five things to know about the importance of family planning:

1. The planning and spacing of births has a powerful impact on the survival of the mother and her child.
2. Children born less than two years after a previous birth are about two-and-a-half times more likely to die before the age of five than children born three-to-five years after the previous birth.
3. Complications of pregnancy and childbirth are the leading cause of death for young women aged 15 to 19 in developing countries. Compared to women in their twenties, girls aged 15 to 19 are twice as likely to die in childbirth.
4. Girls under the age of 15 are five times as likely to die in childbirth.
5. Mortality and morbidity rates are also higher among infants born to young mothers.

Globally, an estimated 215 million women would like delay or avoid pregnancy but do not have access to modern contraceptives. Meeting this need would prevent 53 million unintended pregnancies and 150,000 maternal deaths. Maternal deaths due to unsafe abortion would be reduced by 82 percent.

If family planning, maternal and newborn services were provided simultaneously, the costs of these services would decline by $1.5 billion compared with investing in maternal and newborn care alone. This dual investment would result in a 70 percent decline in maternal deaths and a 44 percent decline in newborn deaths.

The benefits of access to family planning services include:

• healthy birth spacing and smaller families, which improve women’s health;
• improved well-being of families because of the mother's survival;
• better nutrition and education for children;
• the prevention of high-risk pregnancies (particularly for teenage girls, women over 35 and women with many children);
• reduced suffering and stigma due to fistula and other reproductive health problems; greater equality between men and women;
• and more of the parents' time and income allocated to each child.

Links:

• Family Planning Vital to Improving Maternal Health
• Contraceptives Save Lives Factsheet
• Adding It Up: Costs and Benefits of Family Planning
• Supporting Family Planning in Malawi
• Expanding Global Reproductive Rights