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Uneven progress in maternal health worldwide but some countries setting good example
By Lancet,
Oct 11, 2007 - 3:59:37 AM
Progress in maternal health has been uneven, inequitable, and unsatisfactory, but successes in several countries show that change is possible. These are the conclusions of the authors of a Review in this week's Women Deliver Special Edition of The Lancet.
Drs Kirrin Gill, Rohini Pande, and Anju Malhotra, International Center for Research on Women, Washington, DC, USA, and colleagues conclude further that the investment needed for improved maternal health is a minor fraction of global spending and makes financial sense since maternal health interventions are cost effective.
The authors comment on the importance of the reproductive years of women, saying: During these years women not only bear and raise children, but are active members of society in many ways -- as workers, leaders, and key actors in social change and development -- and have the greatest potential to deliver not only for their own lives, but also for broader development.
They note that more than half a million maternal deaths occur worldwide every year, and the huge variability of chances of pregnancy/childbirth related deaths between countries throughout a woman's lifetime.
The Review says that evidence shows women's status and empowerment, in spheres such as education, employment, decision making, intimate partner violence, and reproductive health, affect their maternal health including access to and use of services during pregnancy and childbirth.
Further, they say: Maternal health has profound effects on neonatal and child survival and morbidity and grave implications for the long term wellbeing of children -- particularly girls -- through its effect on their education, growth, and care. They add: Maternal death and illness is costly for families because of high direct health costs, loss of income, loss of other economic contributors, disturbed family relationships, and social stresses.
Progress made in specific countries such as Sri Lanka is analysed in detail, where maternal mortality has fallen from 1600 per 100000 live births in the 1940s to 58 per 100000 livebirths in 2005*.
The authors say: The continued scarcity of progress in maternal health over the past two decades in several parts of the world is disturbing, The little progress is especially of concern for south Asia and sub-Saharan Africa, which have consistently presented the worst maternal health in the world. They add that the connection between maternal mortality, poverty, and status of women is no coincidence, and as such countries which have improved their investment in education and employment for women have also improved their investment in maternal care. They say: Thus, the examples of countries like Thailand and Malaysia suggest that MDG5 is achievable with appropriate financial and political commitment.
Finally, the authors call for more research on how poor maternal mortality affects women's status and productivity, household wellbeing, and economic growth. They say: However, additional evidence alone will not be enough to ensure future progress. Concerted efforts are also needed to change the public perceptions about the severity of the problem and the solutions that are available, and to create a coalition of stakeholders committed to improving maternal health….adequate investment in maternal health and in women will enable women to fulfil their potential to deliver as mothers, individuals, members of families, and citizens.
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