Maternal health

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Maternal health care is a concept that encompasses preconception, prenatal, and postnatal care. Preconception care is recognized as a critical component of health care for women of reproductive age. Goals of preconception care can include providing health promotion, screening and interventions for women of reproductive age to reduce risk factors that might affect future pregnancies. Prenatal care is the comprehensive care that women receive and provide for themselves throughout their pregnancy. Women who begin prenatal care early in their pregnancies have better birth outcomes than women who receive little or no care during their pregnancies. Postnatal care issues include recovery from childbirth, concerns about newborn care, nutrition, breastfeeding, and family planning.

Contents

[edit] Current Issues

Maternal health is one of the basic elements of adequate human capital. Nevertheless, most women do not have access to the health care and sexual health education services that they need. In many developing countries, complications of pregnancy and childbirth (mainly at the level of preconception and prenatal care) are the leading causes of death among women of reproductive age. More than one woman dies every minute from such causes; 585,000 women die every year (WHO). Less than one percent of these deaths occur in developed countries, demonstrating that they could be avoided if resources and services were available (WHO). Every woman can experience sudden and unexpected complications during pregnancy, childbirth, and just after delivery. Although high-quality, accessible health care has made maternal death a rare event in developed countries, these complications can often be fatal in the developing world. Consequently, mothers in developing nations die in childbirth at a hundred or more times the rate in developed nations (MDG). Access to emergency obstetric care, the most important remedy for women in these regions is not highly regarded as a priority. High maternal mortality can lead to significant global health problems and population issues but is not being properly addressed by many nations.

Most people don’t understand that improved maternal health can lead to significant improvements in other global health concerns as well. Additionally, major medical advances usually do not extend to the developing world and so poor birth outcomes continue and further contribute to maternal and infant mortality. Women, who play an important role in families all throughout the world, can help to maintain the health of their villages and communities if they are educated and given the health care they need. Access to health care and appropriate care during pregnancies should be regarded as a basic right for women everywhere. Interventions to improve access to and quality of care in any of these levels easily translate into improved maternal health, especially for areas of greatest need where there are low resources. To be effective however, consideration has to be given to a variety of non-medical factors such as the society’s cultural beliefs and their perception of good health. There exist several obstacles to implementing/maintaining effective maternal health care services in diverse communities. Women usually prefer not to seek services for a variety of reasons. Factors that prevent women in developing countries from getting the life-saving health care they need include distance from health services, cost (direct fees as well as the cost of transportation, drugs, and supplies), multiple demands on their time, and women’s lack of decision-making power within the family. The poor quality of services, including poor treatment by health providers, also makes some women reluctant to use services.

According to the World Health Report in 2004, bad maternal conditions account for the fourth leading cause of women after HIV/AIDS, malaria, and tuberculosis. 99% of these deaths occur in low-income countries; while only 1 of 4,000 women have a chance of dying in pregnancy or childbirth in a developed nation, a woman in Sub-Saharan Africa has a 1 in 16 chance of dying. Furthermore, maternal problems cause almost 20% of the total burden of disease for women in developing countries.

The World Bank estimated that a total of 3.00 US dollars per person a year can provide basic family planning, maternal and neonatal health care to women in developing countries [1]. Furthermore, many different organizations are focusing on educating the public and gaining access to emergency obstetric care for mothers in developing countries.

[edit] What Can Be Done?

Governments and organizations must ensure access to maternal health care services. Most maternal deaths, many health problems among women and children, and the deaths of millions of infants each year could be prevented through:

• routine maternal care for all pregnancies, including a skilled attendant (midwife or doctor) at birth

• emergency treatment of complications during pregnancy, delivery and after birth

• postpartum family planning and basic neonatal care (As mentioned above - such care would cost about $3 per person per year in low-income countries. Basic maternal care alone can cost as little as $2 per person (WHO))

• Improve women’s status and raise awareness about the consequences of poor maternal health. (Families and communities must encourage and enable women to receive proper care especially during pregnancy and delivery.)

[edit] Region, Country

According to the “Investing in Development” portion of the Millennium Development Goals, there are major trends for improvement in maternal health.

Regions that have met MDG (goals) for maternal health:

- Sub Saharan Africa

- Southeastern Asia

- Southern Asia

- Oceania

Regions that are making slow progress:

- Northern Africa

- Western Asia

- Latin America and Caribbean

Regions that are making no and negative progress:

- Eastern Asia

- Europe (Commonwealth of Independent States)

- Asia (Commonwealth of Independent States)

Despite these areas that are making progress, maternal mortality remains high in every region due to:

- little public attention to women’s needs

- inadequate access to sexual and reproductive health information and services

- Any form of education, even 6 years worth of education for girls can drastically improve overall maternal health (UNICEF)

- no emergency obstetric care

- Almost 50% of the births in developing countries take place without a skilled attendant to aid the mother and the ratio is even higher in South Asia (UNICEF)

Although there has been significant improvement in maternal health over the last century, the last decade has shown a slow rate of improvement in maternal mortality and morbidity, especially in Latin America and the Caribbean (MDG). Actually only about 17% of countries are on track to meet these Millennium Development Goals.

[edit] Research and Intervention Suggestions

One of the greatest challenges facing the international public health community is creating sustainable interventions in countries where the needs are greatest. This proves especially difficult in the area of maternal health, as there are so many levels at which initiatives can be taken. Crucial to the success of programs is national ownership, and public-private partnerships to ensure long-term funding. Finally, an ongoing dialogue must be established between governments and researchers to combat maternal mortality. Governments must be able to call upon researchers to help them solve maternal health problems, and research results must be used to formulate national programs and policies. The field of maternal health care would benefit from the development and adoption of a rigorous approach to evaluating new evidence (on the effectiveness, ineffectiveness, or harm of the intervention in relation to a specific outcome), interventions, and/or technology. Among the specific research questions that should be regarded as critically important could be the following:

• What strategies can be used for systematically evaluating new interventions?

• What mechanisms exist for increasing use of effective interventions and eliminating ineffective or harmful ones? • How do social and demographic factors affect outcomes? • Focus on the social determinants of maternal health • Develop better interventions (and evaluations of interventions) for complex problems (e.g., behavioral, social, biological, cultural) arising in marginalized communities. • Examine what factors influence women's health knowledge and behaviors (e.g., Where do they get their information?)

[edit] External links

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