Women and Children First?

In many countries the hours and days close to the birth are the most dangerous for the lives of both the mother and her child and there is, therefore, little cause for celebration.Someone in your immediate circle has probably given birth to a baby in recent months. The happiness that typically surrounds this event in our society is not quite as common everywhere in the world. In many countries—the 75 in Africa and Asia where over 95% of all maternal and infant deaths occur—the hours and days close to the birth are the most dangerous for the lives of both the mother and her child and there is, therefore, little cause for celebration.

This situation is due to a critical lack of maternal health care and the poor quality of the care received by millions of women and newborn babies, especially during and after childbirth. Four out of every 10 births in the world are not attended by a qualified medical professional. The result: every year 300,000 women die during and after pregnancy and about 3 million children die during the first month of life, half of them on the day they are born. Most of these deaths are preventable.

Over the last 25 years the number of maternal deaths per 100,000 live births has gone from 380 in 1990 to 210So why does this situation still exist in the 21st century? If I had to sum up the answer to that question in a single phrase it would be: a lack of political will. The international community has looked the other way for decades. Maternal deaths have never been a priority. And, until recently, the issue did not have the visibility it deserves, particularly in view of the lack of progress in this area over the last 25 years, with the number of maternal deaths per 100,000 live births going from 380 in 1990 to 210 today.

It is worth noting, obvious as it may seem, that in this case we are not fighting a disease for which we do not as yet have the necessary tools (such as new drugs or vaccines). Rather, we are dealing with a simple biological event for which we have, and have applied for many decades in many countries, strategies that minimise the risk to women’s lives. Nevertheless, for decades, resources have been channelled to other groups at the expense of mothers, to other issues that were perceived to be a global threat, such as the fight against HIV/AIDS, or towards interventions that alone will not eradicate maternal mortality (such as increasing the number of antenatal care visits or training traditional birth attendants). Another factor that has contributed to the slow progress in this area is the failure to recognise the contribution of indirect causes of mortality to a large number of maternal deaths (the exacerbation of preexisting conditions), a failure that has held back the integration of malaria and HIV/AIDS programmes with reproductive health interventions.

For decades, resources have been channelled to other groups at the expense of mothersThere are no shortcuts to reducing maternal mortality. Essentially, the only solution is to improve the health systems of the countries where most maternal deaths occur, especially in three key areas: delivery of services, human resources and funding. The countries making the greatest progress are expanding or universalizing coverage of the interventions considered essential for the prevention and treatment of the most common causes of maternal and newborn mortality, including professional attendance at birth and treatment of pneumonia. They are improving the quality of care primarily through a number of interventions: increasing the number of health professionals and enhancing their level of training (improving specific skills related to childbirth and the care of newborn infants, creating incentives for rural health workers, etc.); and putting in place the financial protection mechanisms needed to eliminate the barriers that prevent access to health care (expanding health insurance or conditional cash transfers, for example). Neither should we forget the other factors, not directly related to the health sector, that influence the social determinants of health—such as access to education, governance, the socioeconomic status of women and the degree of their participation in decision-making, management of the environment and strategies for reducing poverty—to which we can attribute no less than half the reduction in maternal and infant mortality in low and middle income countries since the 1990s.

Therefore, despite the slow progress to date, the growing consensus on the need for an approach based on sustainable health systems and involving, in a more integrated way, other sectors in maternal and reproductive health is good news at a time when we are in the process of defining the development agenda for the coming decades.