Maternal mortality: it's time to get political.
نویسنده
چکیده
Nigeria has the 47th highest gross domestic product (GDP) worldwide and is the world’s 8th largest exporter of petroleum. It has a maternal mortality ratio (MMR) of 800/100 000 live births. In contrast, Sri Lanka is 78th on the GDP list but has an MMR of only 92. Among the wealthy countries, Sweden has the 20th highest GDP and a MMR of 2, while USA, despite being the richest country in the world, has a MMR of 17.1,2 If we are to reduce maternal mortality worldwide, it is crucial that we understand the reasons for the wide variation in MMRs. One would expect that the MMR would correlate with the prevalence of major complications of pregnancy, but such complications occur in a remarkably constant 15% or so of pregnancies throughout the world. Nor does the MMR correlate well with a country’s wealth as the examples above show. What is, however, highly predictive of a country’s MMR is the quality of its health services. Comparing each country’s MMR and healthcare quality (as defined in the World Health Organization World Health Report of 2000) shows the two to be closely correlated (Figure 1).2,3 ‘Quality of health care’ is used here in its holistic sense—not just as a measure of the best the country can provide in its large teaching hospitals and private clinics but how effectively good quality health care reaches the country’s poorest in rural areas well away from the capital. It also takes into account the health services’ effect on the nation’s health, the way the health workers treat individuals on a personal level (as regards dignity, confidentiality and client orientation) and the fairness of financial contributions. The UK provides a classic example of the importance of the effect of a good quality health service on maternal mortality rates. It is no coincidence that the major fall in its MMR coincided with the launch of the NHS in the 1940s which provided free care for all at the point of delivery.4 The quality of maternity care also improved greatly at this time as blood transfusions and antibiotics became available. The NHS made these advances available to the many and not just the privileged few. Conversely, the recent crisis at Northwick Park Hospital in London shows how quickly maternal mortality rates can rise if the quality of maternal care deteriorates.5 The impressive second report on the South African Confidential Enquiries into Maternal Deaths emphasises the pivotal role of health services in reducing MMRs.6 Of their ten key recommendations, all but one relates to improvements in the health services rather than introducing new procedures or therapies. They recommend speeding up access to services (better ambulance services and referral systems), service development (better contraceptive/abortion services and improved antenatal screening) and improved quality of care (written protocols, optimising levels of staff and equipment, blood transfusion, partogram use and effective anaesthetic services). The one recommendation that is not directly health service related is the final one that calls for the empowerment of women. If tuberculosis is the disease of poor housing, and gonorrhoea a ‘social disease’, then surely maternal mortality is the classic example of a disease of poor health services. For those of us trying to reduce maternal mortality from a medical perspective, we will be unable to achieve fundamental change without a massive improvement in health services in those areas of the world that are currently poorly served. Indeed, as exemplified in the title of the BJOG 2005 supplement on the developing world, much of the research on DOI: 10.1111/j.1471-0528.2006.01185.x www.blackwellpublishing.com/bjog Editorial
منابع مشابه
Determinants of maternal mortality in Iran 1990-2015: a longitudinal study
Background: Identifying determinants of maternal mortality is essential in developing appropriate health policies for reduction of maternal death. This study aimed to determine the determinants of maternal mortality in Iran during 1990- 2015 and also to identify the trends of these determinants during the same period. Methods: This is a quantitative longitudinal study that has been conducted a...
متن کاملShaping the Health Policy Agenda: The Case of Safe Motherhood Policy in Vietnam
Background Maternal health remains a central policy concern in Vietnam. With a commitment to achieving the Millennium Development Goal (MDG) 5 target of maternal mortality rate (MMR) of 70/100 000 by 2015, the Ministry of Health (MoH) issued the National Plan for Safe Motherhood (NPSM) 2003-2010. In 2008, reproductive health, including safe motherhood (SM) became a national health target progra...
متن کاملTrends and causes of maternal mortality in Jimma University Specialized Hospital, southwest Ethiopia: a matched case–control study
INTRODUCTION Measures of maternal death are fundamental to a country's health and development status. In developing countries, it remains a daunting and largely unmet public health challenge. There were two studies completed over 10 years ago in Jimma University Specialized Hospital to identify trends, but recently there have been many changes in Ethiopia to reduce maternal death. Therefore, it...
متن کاملThe state of political priority for safe motherhood in Nigeria.
Achieving the ambitious maternal mortality reduction aims of the Millennium Development Goals will require more than generating sufficient donor support and carrying out appropriate medical interventions. It also will necessitate convincing governments in developing countries to give the cause political priority. The generation of political priority, however, is a subject that has received mini...
متن کاملThe emergence of political priority for safe motherhood in Honduras.
Each year an estimated 500,000 to 600,000 women die due to complications from childbirth, making this one of the leading causes of death globally for women in their reproductive years. In 1987 a global initiative was launched to address the problem, but few developing countries since then have experienced a documented significant decline in maternal mortality levels. Honduras represents an exce...
متن کاملGenerating Political Will for Safe Motherhood in Honduras
Each year an estimated 500,000 to 600,000 women die due to complications from childbirth, making this one of the leading causes of death globally for women in their reproductive years. Few developing countries have experienced a documented significant decline in maternal mortality levels, despite a global initiative to address the problem. Honduras represents an exception. Between 1990 and 1997...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- BJOG : an international journal of obstetrics and gynaecology
دوره 114 2 شماره
صفحات -
تاریخ انتشار 2007