Maternal Health: Can we meet the Millennium Development Goal by 2015?

An article by Iheoma Okpala.

Never have I been more inspired to think about maternal health. Within the last year two friends of mine became the proud mothers of two bouncing baby girls and a number of other acquaintances and friends are in different stages of their journey towards motherhood. Obviously living in a resource-rich country as the UK they had access to the best that medical care can offer. Both women had excellent antenatal care, meeting their physical and psychological health needs, their babies were born free of serious disease or disability and the birth was directed by skilled midwives and/or physicians in a clean, aseptic environment. All these are known to be essential ingredients to a healthy delivery for mother and child. But it breaks my heart to contemplate that many women across the world are denied such basic rights in a world of i-phones and Nintendo Wiis. Let us pause for a moment and assess the current state of maternal health worldwide and recognise the reasons behind the drive to improve maternal health on a global level.

What is maternal Health?

The WHO defines maternal health as “the health of women during pregnancy, childbirth and the post partum period”. [1] The most common direct causes of maternal morbidity and mortality include haemorrhage (large volume bleeding), infection, high blood pressure, unsafe abortion and obstructed labour. [1] There are also indirect causes of maternal morbidity such as malaria, anaemia and HIV/AIDS which can complicate pregnancy or are aggravated by it [2].

Why is good maternal health so important?

Good maternal health is obviously very important for the wellbeing of an individual mother but there are also positive ramifications for society as well. Mothers play a very important role in the economy of their families and communities [3]. An estimated $15.5 billion is lost in potential productivity when mothers and newborns die [3]. In addition her infant and other children’s survival is seriously threatened and they are more likely to die in the preceding years than children whose mothers are alive [3]. Maternal mortality has long-term implications on a child’s education, care and health [3]. When a mother dies a child is more likely to be delayed in starting primary education and suffer from malnutrition and stunted growth and less likely to be immunized [3].

How can we improve maternal health?

The main factors that have been shown to improve maternal health include low cost/technology interventions such as effective family planning, skilled health worker attendance e.g. midwives, doctors and nurses before, during and after births and effective emergency medical services [3]. Others have postulated that if there is investment in the health services of a country in general then maternal mortality will follow suit [4]. Also there needs to be an educational element to the target in the form of advocacy ventures [4]. These highlight the socio-economic benefits of maternal and newborn health and emphasize maternal mortality as a human rights and equity issue [4]. One of these measures could be through improved rates of female literacy which empowers women to make informed choices about their reproductive health [2].

What is the Millennium Development Goal (MDG) for Maternal Health?

The UN set up a series of Millennium Development Goals back in 2000 which all world nations agreed upon to eradicate world poverty of which goal 5 is to improve maternal health [1]. This target can be further subcategorized: reducing maternal mortality by three quarters and increasing universal access to reproductive health [4]. A wide variety of approaches have been taken and one of the success stories can be found in India. Through a coordinated effort between UNICEF, the Indian government and donors, the Women’s Right for Life and Health project has resulted in a more than 30% increase in the percentage of deliveries assisted by skilled birth attendants in the Rajasthan area [5]. Members of the community have also put in individual effort as shown by the rise in the number of voluntary blood donations for obstetric emergencies [5]. The core principles of the programme have even been written into the national health policy reflecting the importance which the government attaches to reducing maternal mortality [5]. Similar achievements have also been seen in countries such as Nepal, Thailand, Egypt and the Honduras [3].

Are we on course to improve maternal health?

However, this is not a common state of affairs. Increasing evidence suggests that this is the MDG which many countries have made the least progress on. At the global level maternal mortality decreased by less than 1 per cent between 1990 and 2005 which is significantly less than the 5.5 percent yearly improvement needed to hit the target [3]. Also there remains a large inequality in maternal mortality between less and more developed countries [3]; rural and urban areas and those who have been formally educated versus those who have not within countries [3]. For instance in Niger in Sub-Saharan Africa a woman’s lifetime risk of maternal death is 1 in 7 but in the USA it is 1 in 4800 [3]. Women giving birth in urban areas are twice as likely to be assisted by skilled health workers as those giving birth in rural areas [3]. Addressing the other side of the maternal health issue, the fertility rates in 15-19 year olds remain high in some parts of Sub-Saharan Africa despite the fact that they are falling in other parts of the world reflecting poor access to family planning services.

So now we have this knowledge in hand, we should be asking ourselves what can we as students do to improve the situation?

If you are itching to help the cause then consider contacting organisations such as UCL Skip which is a part of UCL Medsin. They have in the past organised summer volunteering project in Ghana. This project involved setting up a vocational school for teenage mothers where they were taught skills that would help them to earn a living and providing childcare during their lesson time to make sure there were no barriers to prevent their attendance.

Or perhaps you are thinking you need to be more knowledgeable on the subject matter before launching into practical assistance. In this case, I would encourage you to attend the Imperial College Maternal Health Conference on Saturday February 20th which brings together world experts on this field. Alternatively, doing an iBSc in International Health and choosing the module on maternal health will really empower you to have a more detailed discussion and analysis of the issues surrounding this complex topic. This article only touches the surface.

So next time you see your mother take time to appreciate her in all her essence. By virtue of being a university student you are an example of what can be achieved when there is excellent maternal health.

_______________________

Iheoma Okpala is a 4th year medical student at UCL.

Further information

• The Who website: www.who.int
• Taking It Global : www. issues.tigweb.org/mortality
• MDED charity: www.mothersdayeveryday.org
• MDG Monitor: http://issues.tigweb.org/mortality
• www.endpoverty2015.org
• UNICEF www.unicef.org/mdg

References