Title:
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Maternal Mortality: Are We Ready To Meet The Millennium Development Goals?
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Authors:
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Published on:
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2010-04-09
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Journal Reference:
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Volume 2 - Issue 1 January - April 2010
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Pages:
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1 - 3
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Download Abstract:
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DOI:
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Giving birth to a child is a normal physiological state that most of women experience at some time in their lives; however, childbirth carries a serious risk of complications and death. Maternal mortality is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.1 The data worldwide suggest that the maternal mortality ratio (MMR) is declining too slowly, especially in developing countries, to meet the Millennium Development Goal 5, which aims to reduce the number of deaths of women during pregnancy and childbirth by three-quarters by 2015 and to provide reproductive health for all females in the reproductive age group.2 The serious issue of maternal mortality is the topic of much debate. The noticeable failure of this issue is a real concern for health care workers. In the developing world, every minute one female dies because of treatable complications of pregnancy, thus leading to the destruction of one family.3 Globally, maternal deaths occur in approximately 400 per 100,000 live births; there is a large discrepancy between developed and developing countries, with the lowest rates of MMR in the developed countries as compared to developing countries.4 According to the World Health Organization, every year in the developing world 35,000 to 500,000 women die during childbirth5 while 375,000 develop pregnancy-related complications such as depression, infertility, chronic pelvic pain, etc.6 The lifetime risk of death of females related to pregnancy in developing countries is 1:75 as compared to 1:7300 in the developed world.2 Significant progress has been made by developing countries towards the Millennium Development Goal of reducing MMR; however, only 23 countries will be able to reduce MMR by 75% by 2015.7 The number of women dying from pregnancy-related causes has declined from 422 in 1980 to 251 in 2008 and is on pace for further decline.7 Statistics worldwide have shown a steady decline in MMR; on average, the global MMR has been falling by 1 % a year2 but in orderto meet the target, a 5.5% annual decline is needed.8 Half of the burden of maternal death is shared by six countries: including India, Nigeria, Pakistan, Afghanistan, Ethiopia, and the Democratic Republic of Congo.7 Data from Pakistan also demonstrate some improvement. The dreadful rate of previous years of 450 maternal deaths per 100,000 births has declined to 276 per 100,000 live births in the past three years8; however, despite lowering the MMR, unfortunately Pakistan will not be able to achieve the Millennium Development Goal by 2015. Maternal deaths result from a wide range of indirect and direct causes. The major direct causes in Asia are hemorrhage (33.9%), sepsis (9.7%), hypertensive disorders (9.1%), ectopic pregnancy (0.5%), embolism (2%), and anemia (3.7), infections including AIDS-related deaths (6.2%), obstructed labour (9%), and complications with abortions (3.9%).9 Indirect causes (20%) include diseases that complicate pregnancy or are aggravated by pregnancy, such as malaria, anemia, and HIV.10 A strong association of maternal mortality was seen with such risk factors as a dearth of information on family planning, provision of poor health care services, early marriages, lack of affordable health care, poor hygiene, and inadequate nutrition.11 A significant decline in maternal mortality was noticed in Malaysia, Sri Lanka, Thailand, and Tunisia because of progress in certain areas, such as better access to skilled birth attendance, improving family planning awareness and usage, and provision of emergency comprehensive obstetric care forfemales of reproductive age.12 There was a significant increase in antenatal care by trained birth attendants in developing countries from 47% in 1990 to 61 % in 2006. However, this coverage is still insufficient to meet the Millennium Development Goals. The regions with the lowest proportions of skilled health attendants at birth were eastern Africa (34%), western Africa (41 %), and south-central Asia (47%), which also had the highest numbers of maternal deaths.13 Antenatal care is an important and fundamental component for the health of the mother and baby and is a basic right of every pregnant female. Provision of antenatal care lessens maternal mortality to a limited extent; however, many antenatal interventions will have a strong positive impact on the health of the baby. Antenatal coverage in developing countries has increased from less than 55% in the early 1990s to almost 75% in a decade. Although this is an improvement, the recommended four antenatal visits during pregnancy are still not available to many pregnant women worldwide. Postpartum care is a neglected area and should receive much more attention both in research and action as most maternal deaths in fact happen there.14 Contraception usage has shown prominent expansion during the past two decades in many regions. However, the unmet need forfamily planning is still inappropriately high in low- and middle-income countries.14 Early marriages are an important issue, creating misfortune for the female gender in this andocentric society where a female has to fight for basic needs and rights, and can be forced to marry at an early age. Most of these females are uneducated and not mature enough to bear the burden of pregnancy. These early marriages are accompanied by early pregnancy and childbirth. Lack of access to reproductive health services and obstetric care by traditional unskilled birth attendants for delivery and abortions places adolescent mothers at risk for unwanted pregnancy and obstetric complications. Repeated unwanted pregnancies and abortions lead to significant nutritional deficiency among these young mothers which further worsens the picture. According to one study, teenage girls over 15 years of age are twice as likely to die from childbirth as are women in their 20s, while girls under 15 face five times greater risk.15 To meet the Millennium Development Goal is a real challenge for health care professionals, requiring a collaborative effort. Pakistan has a weak health delivery system; therefore, there is an obligation to strengthen the basic health care sector and offer health care for all females. Along with the education of unskilled female health workers through capacity building programs, improved coverage and quality of skilled attendance at birth is also strongly recommended. Post-abortion care, better reproductive health services for adolescents, and improved family planning care are important ingredients in MMR reduction. The introduction of programs for the education of health care workers with proper evaluation and monitoring is necessary. Female empowerment through compulsory girls' education would be the most effective line of attack to prepare young women for marriage at a later age, planned and delayed pregnancy, and a better experience of motherhood.16Allocation of funds for health from the government should be increased. One major threat to maternal health is the rapidly evolving AIDS epidemic which has been a contributor to increased maternal mortality; therefore, strategies are required to reduce the impact of this epidemic. Although the current picture is gloomy, there is some hope that the lives of women are at last being valued and collective action has started reduce this tragedy. All south Asian countries are working together to reach the Millennium Development Goal; however, in light of current progress and efforts being made, it is unlikely that we will be able to meet the target. There is still a long way to go. The rate of progress needs to be accelerated, the poorest need to have full access to quality services, and investments need to be dramatically increased if we are to meet our Millennium Development Goal targets. Overall, reduction of MMR requires more and better health care, i.e. a stronger health system at all levels. Maternal health can therefore be considered as a tracer condition for the health system, and improvements in maternal health care can be expected to benefit other facets of care, such as obstetric care, rural hospital care, or primary health care in general. |