The term maternal health refers to women’s health throughout the stages of pregnancy and childbirth as well as during the postnatal period. Maternal health has a direct impact on both the mother and child.
Every day, approximately 810 women die from causes related to preventable childbirth and pregnancy. Providing good quality maternity care in order to prevent these includes supporting the nutrition of mother and baby, treating diseases, supporting women who are exposed to intimate partner violence, and providing universal access to sexual and reproductive care.
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Inequality within maternal health exists across the world, with mortality rates of women during and after pregnancy being significantly higher for certain groups and places. Statistics from the World Health Organization show that 94% of the total maternal deaths across the world happen in low and lower-middle-income countries. Preventable maternal death is a global problem that needs to be solved by providing all women with access to good quality maternity care.
Access to sexual and reproductive care
Around the world, access to sexual and reproductive healthcare is not equal. Research has uncovered significant inequalities in access to such services, with age group, economic status, and urban vs rural location heavily influencing the quality of care available to a person.
Recent data has uncovered that age group seems to create the largest disparities in access to contraception, and economic status and urban-rural residence has the greatest impact on access to maternal health services. Sexual and reproductive health care appears to be less accessible in developing countries, however, even in the US, universal access to such care has not been achieved.
Racial and socioeconomic disparities in the rates of abortion, and unintended births, and unintended pregnancy exist across the US. Experts highlight that these disparities fuel the cycle of disadvantage that is experienced by particular demographic groups, resulting in women not being able to have full control of their fertility.
The COVID-19 pandemic has worsened these disparities, with a recent survey conducted by the International Planned Parenthood Federation (IPPF) revealing that the global delivery of sexual and reproductive healthcare has been impacted by the pandemic.
Vulnerable populations, such as women from low-income and middle-income countries have been disproportionately affected by the shutdown of and delays in sexual and reproductive care, potentially leading to further preventable deaths and lifelong disabilities. The IPPF found that South Asia is suffering from the largest number of closures of clinics offering these services, and Africa has seen the largest number of closures to mobile clinics.
It is important that access to sexual and reproductive care is given special attention in vulnerable populations especially in the time of the global pandemic in order to give women the rights they deserve to control their fertility and to prevent unnecessary death and injury.
Causes of maternal death
While significant progress has been made in recent decades in terms of maternal deaths, a significant number of women are still dying each year unnecessarily due to disparities in access to appropriate healthcare during pregnancy, birth, and after. In 2017, roughly 295 000 women died during pregnancy and shortly after giving birth.
From 2000 to 2017, the global number of maternal deaths per 100,000 live births, known as the maternal mortality ratio (MMR), reduced by around 38%. Although these figures are positive and show that maternal deaths are dropping, there remain great disparities in maternal death, with 94% of women dying during or after giving birth living in low and lower-middle-income countries.
Data shows that 86% of maternal deaths occurred in Sub-Saharan Africa and Southern Asia, with Sub-Saharan Africa accounting for two-thirds of maternal deaths, while Southern Asia accounting for one-fifth. Additionally, age poses a risk factor, with young teens (10-14 years) facing a higher risk of complications and death than older women.
Maternal death and injury are most commonly caused by excessive blood loss, high blood pressure, infection, obstructed labor, and unsafe abortion. Additionally, indirect causes also play a significant role, with anemia, heart disease, and malaria also contributing to maternal deaths.
Around 13% of all maternal deaths are caused by unsafe abortions, with around 47,000 women dying each year due to unsafe abortion. A further five million are hospitalized due to complications of unsafe abortion.
The research highlights that strategies must be implemented to ensure that women around the globe have the same access to maternal health services before, during, and after pregnancy. More research is needed to uncover the multiple underlying factors that lead women in low and lower-middle-income countries to be at a greater risk of maternal death in order to address these issues. Further to this, the data stresses the importance of legalizing abortion to prevent the detrimental effects of unsafe abortion in places where the procedure is not legal.
How we can improve maternal healthcare - before, during and after pregnancy
Inequalities in maternal mortality
Black women are more likely to die during or following birth than white women. The Centers for Disease Control and Prevention state that being black puts women at a three to four times greater risk of maternal mortality.
Other sources, such as data from the American Medical Association, estimate this risk is even more greatly increased, with black women being up to 6 times more likely to die from pregnancy-related causes than white women. This racial disparity is greater in the US than in any other industrialized country.
These figures highlight a major human rights emergency. The data underlines that there are a significant number of women losing their lives unnecessarily due to inequalities in maternal health.
Experts have concluded that there are multiple factors contributing to this inequality such as a lack of access to care and poor quality care offered to women at lower socioeconomic levels. Additionally, a recent report has found that bias and stereotyping are also impacting the level of health care that black women receive, a fact that is particularly concerning as it shows that prejudice is playing a part in causing unnecessary death.
A greater level of health surveillance and the development of effective prevention strategies are needed in order to protect black women from these inequalities and reduce the number of women dying unnecessarily during and after childbirth. Education, training, and a focus on reducing racism and bias are key to eliminating racial inequalities in maternal mortality.
References
- COVID-19 pandemic cuts access to sexual and reproductive healthcare for women around the world. International Planned Parenthood Federation. Available at: https://www.ippf.org/news/covid-19-pandemic-cuts-access-sexual-and-reproductive-healthcare-women-around-world
- Dehlendorf, C., Rodriguez, M., Levy, K., Borrero, S. and Steinauer, J., 2010. Disparities in family planning. American Journal of Obstetrics and Gynecology, 202(3), pp.214-220. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2835625/
- Kumar, M., Daly, M., De Plecker, E., Jamet, C., McRae, M., Markham, A. and Batista, C., 2020. Now is the time: a call for increased access to contraception and safe abortion care during the COVID-19 pandemic. BMJ Global Health, 5(7), p.e003175. https://gh.bmj.com/content/5/7/e003175
- Maternal Health. World Health Organization. Available at: https://www.who.int/health-topics/maternal-health
- Sully, E., Biddlecom, A. and Darroch, J., 2019. Not all inequalities are equal: differences in coverage across the continuum of reproductive health services. BMJ Global Health, 4(5), p.e001695. https://gh.bmj.com/content/4/5/e001695.info
- Why Are Black Mothers At More Risk Of Dying? Alice Broster. Forbes. Available at: https://www.forbes.com/sites/alicebroster/2020/07/22/why-are-black-mothers-at-more-risk-of-dying/
Further Reading
Environmental stressors linked to fetal brain development challenges