International community fails to reduce rate of women dying in childbirth

The rate of women and girls dying from childbirth and unsafe abortions in the Philippines has not greatly improved since 1990.

The rate of women and girls around the world who die from childbirth and unsafe abortions is still unacceptably high, despite a global agreement to address the problem 15 years ago.

Every day hundreds of women and girls die from unsafe abortions and preventable complications during childbirth.

Complications in pregnancy and childbirth are the second-most common causes of death for 15 to 19-year-old women around the world, after suicide, the United Nations Population Fund (UNFPA) says.

The same complications are a leading cause of disability for women who survive.

While ways to prevent maternal deaths are well known, the latest estimate suggests the international community has failed to reduce the maternal mortality rate to a target ratio set at the turn of this millennium.

“Maternal mortality is a problem that’s significantly faced by poor women in remote rural communities”

The 'maternal mortality ratio' represents the number of women who die of pregnancy or abortion-related issues per 100,000 live births.

Reducing this ratio was one of eight Millennium Development Goals set by the United Nations in 2000. The aim was to decrease the 1990 ratio of 380 per 100,000 live births by 75 per cent this year.

The most recent estimate in 2013 was a ratio of 210, more than double the target of 95 by this year.

The World Health Organisation (WHO) says most maternal deaths are preventable, but 99 per cent of maternal deaths occur in developing countries.

Doctor Mohammed Ali from Curtin University’s School of Nursing and Midwifery told SBS the Three Delays Model described the majority of maternal deaths worldwide. 

According to the model, the delays that face pregnant women in getting medical attention are:

  • A failure for pregnant women to recognise they have a problem - causes include illiteracy, financial restrictions or acceptance of death.
  • The delay of getting to a hospital - through poor infrastructure and expensive or poor transport options.
  • Delays once pregnant women reach the hospital - through lack of medicines or facilities and improperly trained staff.

There were a range of other issues that made seeking medical attention hard for pregnant women in developing countries, including human trafficking and patriarchal social norms, Dr Ali said.

The latest estimate for Africa's maternal mortality ratio in 2013 was 500 per 100,000 live births, which is the highest ratio of any region.

Associate Professor Soumitri Varadarajan of RMIT said a lack of infrastructure contributed significantly to a high maternal mortality ratio. 

His research focuses on social innovation, product design and service design.

Greater access to mobile phone technology across Africa meant people could call ambulances, but poor roads meant ambulances could not get to people in trouble, Prof Varadarajan said.

“You build a road and you can save lives,” Prof Varadarajan said.

He said poor mothers in urban environments would have a better chance at surviving compared to pregnant women in many remote communities.

“Maternal mortality is a problem that’s significantly faced by poor women in remote rural communities,” he said.

The World Bank recently said, with its release of World Development Indicators 2015, the maternal mortality ratio’s decline was not enough to achieve the Millennium Development Goal for reduced maternal mortality.

But Professor Varadarajan said conditions for mothers around the world had improved.

“There’s been a significant drop in maternal mortality, which means lots of good things are happening,” he said.

He said policies in the Indian state of Tamil Nadu were a good example of positive results with limited funding.

Maternal deaths in Tamil Nadu are met with verbal autopsies where medical professionals identify systemic issues that contribute to maternal deaths to prevent similar cases occurring in future.

The WHO has identified Tamil Nadu as a success story.

Analysis of verbal autopsies allowed authorities to determine that six per cent of maternal deaths in Tamil Nadu were due to a lack of access to medical abortion treatments, WHO said.

In 2006, Tamil Nadu had an estimated maternal mortality ratio of 90 per 100,000 live births, compared to the rate of 301 per 100,000 across India that year. Tamil Nadu has India’s second largest state economy.

The 2013 estimate of India’s maternal mortality ratio was 65 per cent lower than 1990.

WHO says just 19 countries had achieved the goal of a 75 per cent reduction between 1990 and 2013.

Nepal and Rwanda were two of those 19 countries.

The Trends in Maternal Mortality 1990 to 2013 report said Rwanda and Nepal had implemented successful long-term policies to address basic health needs.

Australia's maternal mortality ratio has decreased slightly since 1990, but Australia’s ratio in 1990 was relatively low at nine per cent when the global rate was 380 per 100,000 live births.

Women younger than 18 years of age and older women who have had many births are most at risk of dying during childbirth.

Maternal mortality ratios were higher in countries that had higher proportions of young people, UNFPA said.

“Studies have shown that, compared to older women, younger women are more likely to wait to seek abortion, use an unskilled abortion provider or use dangerous methods to self-abort, and delay seeking care for complications,” UNFPA said.

“Girls under age 15 five times more likely to die during childbirth than women over 20.”

Unsafe abortions can cause maternal death and each year an estimated 2.5 million adolescents had unsafe abortions, UNFPA said.

The WHO's most recent estimate of unsafe abortions was 21.6 million unsafe abortions every year, including girls.

Complications in pregnancy and childbirth are the second-most common causes of death for 15 to 19-year-old women around the world, after suicide.

However, the women who do not die often suffer, UNFPA said in the Saving Mothers' Lives report.

“For every woman who dies, about 20 others are seriously disabled, or chronically affected, many of their lives severely curtailed,” UNFPA said.

A common condition for women to live with after complications in pregnancy is obstetric fistula, a condition where a hole develops in the vagina as a result of prolonged obstructed labour.

The condition can be prevented by accessing good medical care during labour.

In 2010, UNFPA said the condition affected 3.5 million women worldwide.

"Although the condition has been eliminated in the developed world, obstetric fistula continues to afflict the most impoverished women and girls, most of whom live in rural and remote areas of the developing world,” the report said.

Source SBS

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