Maternal health in poor countries: the broader context and a call for action

One in 16 women die in pregnancy or childbirth in sub-Saharan Africa compared with one in 2,800 women in developed countries. What is the broader context of this problem and what action needs to be taken globally to reduce maternal deaths?

In September 2000, 189 countries committed to supporting the Millennium Development Goals, including the fifth goal, to reduce maternal mortality by 75 percent from 1990 to 2015. A number of countries, including Egypt, Thailand and Bangladesh, have already shown that this enormous task is possible, yet it is unlikely that most African and some Asian countries will reach the target.

This paper, the fifth in The Lancet Maternal Survival Series, looks at the broader context of maternal health in poor countries, including the social and economic vulnerability of women in pregnancy, and emphasises the importance of wider strategies such as poverty reduction and empowering women. It assesses the consequences of maternal health problems other than death, links to other global survival initiatives such as HIV, and considers the financial and political context of maternal mortality. It also considers the programme implications of the close association between the mother, the foetus and the child.

The paper finds that:

• Strategies targeting the intrapartum period are most likely to reduce maternal mortality, especially if women are able to give birth in a health centre, attended to by a midwife and her team. Complementary priorities include family planning and safe abortion.   
• Poor women in rural areas are in the greatest need, especially in sub-Saharan Africa and south Asia.
• If we can achieve high coverage of intrapartum care based in health centres, a qualitative change in labour monitoring and in early care for preterm newborn babies is likely to translate into a fall in early neonatal mortality.
• User fees reduce the use and quality of maternal health services, especially among the poorest women.
• Good maternal health is essential for the welfare of the entire household, as women are largely responsible for providing food, care and emotional support. Improving access to good quality intrapartum care at health centres is thus an important poverty eradication strategy.
• Reducing maternal mortality is likely to require a long-term effort using multiple approaches simultaneously. Long-term support will be needed to speed up progress via health systems.

If the MDG-5 is to be reached, the focus must remain on this target, while also retaining the broader perspective. Action will be needed at all levels, from governments to the international community and health experts, and between global initiatives. The report calls for the following:

• Donors and governments must come up with a clear strategy on how to reduce maternal mortality, taking the above findings into account.
• Donors should focus funds through sector-wide support and invest in monitoring methods to ensure all governments, donors and others involved are held to account.
• Countries must put measures in place to help protect the poorest families from financial disaster caused by unaffordable delivery charges. 
• Governments must plan for the training and deployment of maternity health workers, especially midwives, and retain them by offering incentives and improving work conditions.
• Better monitoring is needed of progress made in improving maternal health. Data quality must be improved and a group should be set up to monitor and evaluate maternal outcomes.

Source(s):
‘Maternal health in poor countries: the broader context and a call for action’, The Lancet Maternal Survival Series 386, pages 1535-1541, by Véronique Filippi, Carine Ronsmans, Oona M.R. Campbell, Wendy J. Graham, Anne Mills, Jo Borghi, Marjorie Koblinsky and David Osrin, 2006 Full document.

Funded by: UK Department for International Development (DFID); Initiative for Maternal Mortality Programme Assessment (IMMPACT)

id21 Research Highlight: 23 January 2007

Further Information:
Véronique Filippi
Department of Epidemiology and Population Health
London School of Hygiene and Tropical Medicine
Keppel Street
London WC1E 7HT
UK

Tel: +44 (0) 20 79272874
Fax: +44 (0) 20 76374314
Contact the contributor: veronique.filippi@lshtm.ac.uk

'Towards 4+5', DFID Research Programme Consortium

Initiative for Maternal Mortality Programme Assessment (IMMPACT)

Other related links:
'Reducing the cost of maternal health services to the poorest households'

'Understanding maternal mortality: achieving the fifth Millennium Development Goal'

'Maternal health in sub-Saharan Africa: tackling the skills shortage'

'Professional maternity care: scaling up provision in poor countries'

'Reducing maternal mortality: what strategies work?'

'Making childbirth safer for mothers in Nepal'

'Women’s groups’ perceptions of maternal health issues in rural Malawi'