11 April – The International Maternal Health and Rights Day
Written by: Pokam Feunou Ornella and Rebecca Mwambegele under supervision by Aswan Tai, InciSioN Education team, 2019.
Every mother every child: our future
Every child comes from a mother, and every mother was once a child. Maternal health is the peak of a reliable health system, and with proper care results in a better health outcome.
Surprisingly enough, while 62% of women worldwide receive at least four antenatal care visits worldwide, the rates are much lower in regions with the highest rates of maternal mortality, with urban women far more likely to receive antenatal care than their counterparts (1). Antenatal care should include identification of pre-existing health conditions, early detection of complications arising during pregnancy, health promotion and disease prevention as well as birth preparedness and complication planning (2). In South Asia for example, 46% of women receive the recommended antenatal health care visits (1). This means that 5 in 10 women do not, and inadvertently, might result into having birth complications which would have been avoidable.
More to that, access to healthcare for mothers is a key health determinant and is still a big challenge for many low- and middle-income countries. This pitfall has also contributed to increasing maternal mortality as portrayed in Cameroon where in 2016, a 31-year-old mother of twins arriving with labour complications at a public hospital was denied care for hours because she could not afford treatment which precipitated the death of her and her twins (3). There is no excuse for this act and it is impossible to think of her death as a mere medical accident.
Denying care to pregnant women because they cannot afford their medical bills may contribute to increasing maternal death and consequently neonatal death as seen in the above scenario. For every pregnant mother we must consider two lives and we must protect the dignity of human lives. The aforementioned also reflects obstetrics violation. Obstetric violence is a Human Rights violation, as WHO (4) expresses in its statement “The prevention and elimination of disrespect and abuse during facility-based childbirth”.
Another major and unfair situation contributing to maternal death is unsafe abortion. The WHO defines unsafe abortion as a procedure for terminating a pregnancy that is performed by an individual lacking the necessary skills, or in an environment without the minimal medical standards, or both conditions (5). Approximately 50% of all abortions performed around the world are unsafe, and this proportion has increased in the past decades. This account for 8% of all maternal death worldwide; at least 22800 women die each year between 2010-2014 from complications of unsafe abortion, reported by Guttmacher (6).
A big gap in mortality rate is also seen between first and third world countries. The maternal mortality ratio in developing countries in 2015 is 239 per 100 000 live births versus 12 per 100 000 live births in developed countries. About 830 women die from pregnancy- or childbirth-related complications around the world every day. It was estimated that in 2015, roughly 303 000 women died during and following pregnancy and childbirth. Almost all of these deaths occurred in low-resource settings, and most could have been prevented (7). However, that is about to change as more governments reevaluating their decisions and prioritizing maternal health care, and the construction of multiple BEMOC (Basic Emergency Obstetric Care Centers). With countries such as Tanzania creating strategic health plans to make sure these plans are implemented (8), provision of mobile health technology in Ghana (9), removal of user fees in Lesotho (10) and mobile health interventions (11), a better future is guaranteed.
As InciSioN, our major focus is in creating a safe space where students can contribute to matters such as this. We firmly believe that better maternal health care will be a great starting point in creating better health care. We support all efforts being done to promote maternal health care worldwide, and are looking forward to work together with all major stakeholders in achieving better health for all.
We acknowledge that the young population is at a higher risk for complications and death as a result of pregnancy than other women. We also consider 3 obstetric delays; delay in seeking care, delay in accessing care and delay in receiving care to address maternal mortality thus advocate for better healthcare before, during and even after the pregnancy to safeguard both the mother’s and child’s health. This does not necessarily have to be limited to hospitals but more of extended programs to reach the community at large, including seminars and in-school projects.
All women should have full access and autonomy over the range of their reproductive and sexual rights, including safe obstetric care, safe abortion, access to family planning. These services should be affordable, legal and free of stigma and discrimination yet we see that many countries especially LICs (low income countries) have not put this to reality.
And this is why we believe advocating and increasing awareness on this matter can make the quantum leap we desire with mitigating maternal mortality in LICs. Beginning from educating the healthcare personnel ranging from midwifery, nurses, nursing students, medical students, general practitioner on valuing a mother health and the child and understanding importance of humanized birth and empowering women during pregnancy. Humanized birth is putting the woman giving birth in the center taking into account cultural, social and ethnicity aspects, thus it is not limited to technical skills and the birth.
We would also like to advocate for proper mental health support through the pregnancy, as well as encourage them to attend clinics on agreed dates, stressing on why proper clinic attendance is important for both her health and the baby’s. Not forgetting encouraging community and hospital access to family planning services, counselling on abortion implications for every sexually active woman with no stigma and discrimination of age, religion, marital status and others. This is in line with the fact that we strongly believe every woman has a sexual and reproductive health right that is to choose when and how to reproduce and to prepare physically socially and mentally for it, hence promoting health of a woman.
As it is the 21st century, it is our desire that no more women die because of trying to bring a new life. #no death for life, we are at a position where we don’t have to see things get much worse before we decide to do better. We support any and all legal efforts that target promoting maternal healthcare worldwide and we hope that tomorrow, a different story will be told.
- Antenatal care – UNICEF DATA [Internet]. [cited 2019 Apr 4]. Available from: https://data.unicef.org/topic/maternal-health/antenatal-care/
- Number of facilities per 500,00 providing basic and comprehensive emergency obstetric care — MEASURE Evaluation [Internet]. [cited 2019 Apr 4]. Available from: https://www.measureevaluation.org/prh/rh_indicators/womens-health/sm/number-of-facilities-per-500-00-providing-basic
- Nehsuh Carine Alongifor, Women Deliver Young Leader, Maternal Mortality in Cameroon: An Urgent Need for Action, April 4, 2016. Available at https://womendeliver.org/2016/maternal-mortality-in-cameroon-an-urgent-need-for-action/
- World Health Organization. The prevention and elimination of disrespect and abuse during facility-based childbirth, 2014. Available from:http://apps.who.int/iris/bitstream/10665/134588/1/WHO_RHR_14.23_eng.pdf?ua=1&ua=
- World Health Organization, Safe abortion: technical and policy guidance for health systems – 2nd ed., 2012. Available from:http://apps.who.int/iris/bitstream/handle/10665/70914/9789241548434_eng.pdf;jsessionid=C1CCA6FFD1BE18DD3F4B2E2D50A775E3?sequence=1, accessed on December 2nd, 2018.
- Guttmacher Institute, Factsheets/ Induced Abortion Worldwide, Global incidence and trends. March 2018, Available from:https://www.guttmacher.org/fact-sheet/induced-abortion-worldwide
- 7. World Health Organization, News/Fact sheets/Detail/Maternal mortality. Available from: https://www.who.int/news-room/fact-sheets/detail/maternal-mortality
- 8. United Republic of Tanzania Ministry of Health and Social Welfare. The National Road Map Strategic Plan to Accelerate Reduction of Maternal, Newborn and Child Deaths in Tanzania [Internet]. 2008 [cited 2019 Apr 4]. Available from: https://www.who.int/pmnch/countries/tanzaniamapstrategic.pdf
- Laar AS, Bekyieriya E, Isang S, Baguune B. Assessment of mobile health technology for maternal and child health services in rural Upper West Region of Ghana. Public Health [Internet]. W.B. Saunders; 2019 Mar 1 [cited 2019 Apr 4]; 168:1–8. Available from: https://www.sciencedirect.com/science/article/pii/S0033350618303731
- 10. Steele SJ, Sugianto H, Baglione Q, Sedlimaier S, Niyibizi AA, Duncan K, et al. Removal of user fees and system strengthening improves access to maternity care, reducing neonatal mortality in a district hospital in Lesotho. Trop Med Int Heal [Internet]. John Wiley & Sons, Ltd (10.1111); 2019 Jan 1 [cited 2019 Apr 4];24(1):2–10. Available from: http://doi.wiley.com/10.1111/tmi.13175
- 11. Dol J, Campbell-Yeo M, Tomblin Murphy G, Aston M, McMillan D, Richardson B. Impact of mobile health interventions during the perinatal period for mothers in low- and middle-income countries. JBI Database Syst Rev Implement Reports [Internet]. 2019 Feb [cited 2019 Apr 4];17(2):137–46. Available from: http://insights.ovid.com/crossref?an=01938924-201902000-00003