Maternal and Child Health III

The Global Maternal Health Scenario

We now turn our attention to global maternal health. We will examine the progress made in reducing maternal mortality and also look at the issues which will be the focus beyond 2015. 421Let me first define two terms. Maternal death and maternal mortality ratio because these two terms would be used repeatedly in this particular lecture. Maternal death is defined as the death of a woman while pregnant or within 40 days of termination of pregnancy from any cause related to or aggravated by the pregnancy or its management. Thus, maternal death is a death of a woman related to pregnancy and its complications. Maternal mortality ratio is defined as number of maternal deaths per 100,000 live births. Please note that this is a ratio where maternal deaths are the numerator and live births, babies born live after pregnancy are in the denominator. Where do we stand in regard to the status of maternal mortality? Maternal mortality has been the focus of our endeavors, worldwide. It used to be extremely high and it continues to be high, at an unacceptable level. Although we have made progress and we’ll come to that in a moment. Even today however, approximately 800 women die from preventable causes related to pregnancy and childbirth. In 2013, 289,000 women died during and following pregnancy and childbirth. More remarkably almost all of these deaths, 99% of them occurred in developing countries. There are hardly any maternal deaths in the developed world. This is the quantum of preventable mortality among women who go through pregnancy in the natural course of their lifetime. This map shows the distribution of maternal mortality ratio in various parts of the world in the year 2013. The reds and the oranges are high MMR where are the blues and the light blues are the lower maternal mortality rates. The deepest blue is just a rate of less than 10 per 100,000 maternal mortality ratio and you can see that that color is present only in the best of the, of the developed world. The deep red is a maternal mortality ratio of 500 per 100,000 live births.

422Extremely high. Fifty times that in the blue zones that you notice. It’s also obvious from this map that the highest rates of MMR prevail in sub-Saharan Africa. Indian subcontinent and other parts of Africa are somewhere in the middle where the rates are between 200 to 300 per 100,000 live births. So the agenda of maternal mortality reduction is the agenda of poor nations of sub-Saharan Africa and relatively poor nations of Asian subcontinent. The Millennium Development Goal number V relates to improving maternal health. And its specific focus is reduction in maternal mortality. And the target of MDG V is reduction in MMR or maternal mortality ratio by three-quarters, 75% from the 1990 baseline, to 2015 as the timeline. So MDG V is about reducing maternal mortality ratio by 75%, between 1990 and 2015. Let’s see what progress has been made in the context of MDG V since 1990. Between 1990 and 2013, and 2013 is a year for which we have the most updated data, maternal mortality worldwide has dropped by 50%. So if you notice, the number of maternal deaths on the right side, 1990, 523,000 and in 2013 maternal deaths are down to 289,000. It’s about 50% reduction. If you look at the ratio, the maternal mortality ratio, it declined from 380 per 100,000 live births as we defined shortly ago, from 210 globally in the year 2013. It’s again, an outstanding reduction, close to about 50%. More importantly the MDG initiatives have been a trigger for faster reduction in maternal mortality ratio. Between the year 1990 and 2005, the average annual percent change in MMR was the reduction of 2.2% each year. And this accelerated to 1.5 times in the time period of 2005 to 2013 to 3.3%.

441There is no doubt that the political commitment, increased resources, better monitoring and better and higher scale up of effective interventions triggered by the Millennium Development Goals, has resulted in saving additional lives of mothers. However, only 10 high burden countries of the 75 will achieve the MDG V. The rest of the world and the world as a whole would unfortunately still fail to achieve MDG V. And that’s the unfinished agenda that we carry beyond 2015. But let’s look at the regional progress and inequities in maternal mortality ratio. As you would see from this graph, the global community as a whole reduced MMR from 380 to 210 between 1990 and 2013. A decline of 45%. This decline was greater in South Asia, the middle two bars, from 530 to 190. The sub-Saharan Africa, where we see the highest rates also made a significant reduction, the blue is much bigger than the red. And this decline was 48%. So there has been progress all across the world, including the tough places like the African continent and the Indian subcontinent. The progress has been uneven and this needs to be corrected. So there are inequities where we need to invest in order to make sure that there is more even progress and faster progress in time to come. When we look at the causes of maternal deaths and try to derive lessons for averting maternal deaths, something very clear emerges. Thirty-five percent, more than one-third of maternal deaths occur because of hemorrhage or bleeding, triggered by childbirth. High blood pressure, eclampsia accounts for 18% of maternal mortality. Infections, 8%. Unsafe abortion, unsafe abortions account for 9% of maternal deaths.

 

442This is the global scenario. How do the mothers survive the period of pregnancy and childbirth? One of the key things that we know that works is conducting delivery in safe hands. Providing care during labor and childbirth by a skilled health professional, a doctor or a nurse or a midwife. Therefore for MDG V, a key indicator is births attended by skilled health personnel. And if you look at the coverage of this, you will note that in high income countries, and even in upper middle income countries, the two bars on the right side, almost every birth is being attended by skilled personnel or skilled professionals. Every mother. On the other hand, on the extreme left, in low income countries, this proportion is less than 50%. And low and middle income countries are somewhere in the middle. You can see that further reduction in maternal mortality is related to how best we ensure that the labor and delivery is in the hands of skilled people. And, this inequity between the low income countries and the better off countries has to be bridged. This is the centerpiece of our strategies to improve maternal mortality. Skill care at delivery coupled with the emergency obstetric care which would involve emergency caesarian section and blood transfusion and manual evacuation of placenta. These interventions are at the heart of our efforts to reduce maternal mortality. Then unsafe abortion need to be addressed through legalization of abortion services and abortion as a, as a, as a domain and its acceptability in the society coupled with expertise to undertake safe abortion. These are the key approaches to addressing maternal deaths. In the context of maternal health MDG, namely the MDG V. This MDG is linked to very interestingly many other MDGs. It’s related to eradication of poverty, access to basic services. It is linked to improving the status of gender and empowering women and empowering communities. It’s linked to its impact on child mortality and child survival. The MDG IV, it is linked to universal education because educated women are less likely to, to have adverse pregnancy outcomes and maternal deaths. It’s also linked to the HIV related MDG because a part of mortality of mothers is linked to HIV. In some ways, it is at the heart of the entire MDG effort and we also view MDG V as a final common pathway and an indicator of overall development. And of course global partnerships, environmental sustainability are linked in ensuring empowerment of women, good health of mothers, and above all very, very low levels of maternal mortality.


OpenEdition sugere que esta publicação seja citada da seguinte forma:
Pedro Pereira Leite (18 de Maio de 2015). Maternal and Child Health III. Global Heritages. Recuperado em 19 de Abril de 2026 de https://doi.org/10.58079/p2or


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