Bwera Hospital, Kasese, Uganda
Global Status of Women's Reproductive Health
Though significant progress has been made in the past 15 years, sub Saharan Africa has fallen short of meeting Millennium Development Goal #5 - Improving Maternal Health. The two targets of this goal were reducing maternal mortality by 75% worldwide, and achieving universal access to reproductive health. Maternal mortality did decline by 45% globally during this period, but this progress was not evenly distributed, and a woman in sub Saharan Africa still stands a 1/16 chance of dying in childbirth. Many women who do survive live with debilitating, and often permanent health issues as a result of preventable complications in childbirth.
Common causes of Maternal and Neonatal Mortality
Death during childbirth is almost always preventable. 99% of maternal deaths occur in the developing world, mostly due to lack of access to proper medical care before, during, or after birth. 10-15% of births result in complications, and delays in care seeking and receiving are responsible for 75% of maternal death. Listed below are some of the most common preventable and treatable causes of maternal and neonatal mortality.
Severe bleeding, or hemorrhage, normally occurs after birth, and can kill a woman very quickly. These deaths are normally preventable if the woman is injected with oxytocin, a hormone which helps the uterus contract and reduces risk of post-partum hemorrhage. Oxytocin is widely available at hospitals, even in rural or undeveloped areas.
Obstructed labour is a condition where the fetus cannot progress into the birth canal, often due to cephalo-pelvic disproportion - when the mother's pelvis cannot accommodate the size of the baby's head or other presenting body part. This can be due to a narrow pelvic opening, a large baby, or malpresentation. As a result, the baby cannot move through the birth canal, and the woman will labour for a long time, sometimes for days. A cesarean section is almost always necessary in these cases, and cannot be performed at a local health center. If the mother does not have access to surgery, obstructed labour can result in uterine rupture and sepsis, both of which are life-threatening to the mother and/or baby. Many women suffer from obstetric fistula - a hole connecting the uterus and bladder and/or rectum, which causes incontinence and social ostracization. The WHO estimates that more than 2 million women live with untreated obstetric fistula in sub Saharan Africa and Asia. To learn more about the importance of fistula prevention and treatment in the developing world, visit the Fistula Foundation, or the Global Fistula Map.
Pregnancy-induced high blood pressure, or pre-eclampsia and eclampsia, normally begins in the third trimester, and can be treated before contractions begin using drugs such as aspirin, calcium supplements, and magnesium sulphate. Left untreated, eclampsia can lead to many adverse health outcomes for both mother and fetus, including maternal death. Blood pressure monitoring to detect pre-eclampsia is an important part of antenatal care visits.
Pre-existing conditions, such as HIV infection or malaria during pregnancy, can have serious implications for the health of the mother and fetus. It is therefore important that mothers are aware of their conditions and treated accordingly during antenatal care visits.
Socioeconomic factors impacting Maternal Health
Skilled birth attendants serve one of the most important roles impacting maternal health worldwide. Less than half of births in sub-Saharan Africa are attended by a skilled attendant, meaning that she will be unlikely to have access to surgery or treatment for hemorrhage, sepsis, or other life-threatening conditions. For country by country data on skilled attendance at birth, see the UNICEF Global Database report provided on the right. The easiest way to increase the number of women delivering with a skilled attendant is to encourage women to give birth in health centers, rather than remaining at home for labour.
Global Statistics on Maternal Health (WHO, 2013):
Maternal deaths per day: 800*
Maternal deaths 2013: 289,000 Neonatal deaths 2013: 2,762,592
MMR in Sub Saharan Africa: 510
MMR in Uganda: 440 *One pregnant mother dies every 2 minutes.
Global causes of Maternal Mortality - WHO (pdf)
WHO Report: Maternal Health in Uganda (pdf)
UNICEF Report: Maternal Health Worldwide
State of the World's Midwifery Report 2014 (pdf)
Skilled attendance at birth-UNICEF by country (excel)
Mama Rescue addresses maternal health by encouraging the WHO-recommended standard of 4 antenatal care visits, and providing free transportation for labor in health centers with skilled midwives, and emergency transport to hospitals should complications arise.
Antenatal care and attended delivery
Only 37% of births in sub Saharan Africa were attended by a skilled midwife in 2014 (UNICEF 2014).
Antenatal care (ANC) visits are an integral part of a maternal health program, but only half of mothers worldwide receive the recommended 4 ANC visits. These appointments include blood pressure monitoring, delivery planning, and malaria prophylaxis.
Emergency obstetric care
10-15% of mothers will require a C-section; a procedure which is not possible at a small health center.
Though cesarean-sections may be over-performed in some parts of the world, women in developing countries who require the operation cannot always access it. In many cases, women labor for days at home because they cannot reach the hospital. This can result in death or permanent disability of the mother. Many other deaths result from severe bleeding or infections, which are almost always treatable if the proper care and medicine is available.