Three Pillars of Maternal Health


A woman lies bleeding in the emergency room of the University of
Ibadan College Hospital in Nigeria. Though her baby was delivered safely, she’s suffering
from postpartum hemorrhage, an easily treatable condition that nonetheless kills
approximately 160,000 women in the Global South annually—about 30 percent of all
maternal deaths. In the past, this woman would likely have died in as little as two hours.

But today, a low-cost, wet-suit-like outfit can save her. Made of neoprene and Velcro,
the AntiShock Garment or LifeWrap, enfolded around the new
mother’s lower body, can decrease bleeding and keep blood in her vital organs. It will
help stabilize her, allowing time to transport her to an appropriate facility, for a surgeon
to be called or for enough blood to be collected for her transfusion.

This is one of several low-tech, low-cost interventions that could
dramatically reduce maternal mortality in the Global South, where each
year more than half a million women die from preventable
pregnancy related causes—one every minute.

In 2000, the United Nations
identified reduction of maternal mortality as one of eight Millennium
Development Goals (MDGs) — global priorities designed to help end poverty, decrease maternal and infant mortality, ensure gender equality, combat HIV/AIDS to name a few. Yet
this issue is struggling for visibility and funding, lost in the
competition for billions of dollars allocated for global health.
Consequently, while such innovations as the AntiShock Garment offer
women real hope, the challenge is how to make them widely available.

Another helpful postpartum intervention
is the inexpensive, uterine contracting
drug misoprostol, which
has been shown by research in India to
prevent up to half of all postpartum
hemorrhaging if administered within a
few minutes after delivery. If a woman
does start bleeding, the AntiShock
Garment then stabilizes her. Or, if a
woman suffers from eclampsia due to
complications from hypertension—
which can lead to convulsions and accounts
for about 12 percent of all
maternal deaths—she can best be
helped by the drug magnesium sulfate.
But that remedy is rarely used because
of problems with availability, staff
training or health-facility readiness.

In the past, experts in the maternal
health field have disagreed on priority
actions. But within the past year a consensus
has emerged on the three pillars
necessary to support a sustained
drop in pregnancy-related deaths:

  • Comprehensive reproductive health
    care must include contraception to
    avoid unwanted births and prenatal
    visits to monitor pregnant women.
  • Skilled attendance at birth must
    mean ensuring that danger signs are
    identified early for at-home births,
    or births in modest primary healthcare
    centers, and that timely actions
    are taken to prevent complications
    or to bring women to more sophisticated
    facilities.
  • It is a critical investment to increase
    capacity for emergency obstetric
    care, including operating rooms for
    C-section deliveries and stocked
    blood banks for transfusions.

 

These interventions can be funded and
introduced without overhauling health
systems. Other steps needed to improve
maternal health aren’t so clearcut.
But based on the billions spent
each year on such global health issues
as HIV/AIDS—not to mention expenditures
for issues other than health—
it’s obvious that resources exist.

What’s missing is the political will.
For the global community to meet
commitments made in the Millennium
Development Goals, attention
and resources need to be redirected,
and greater concern put forth by
health experts, government officials
and ordinary citizens. As Thoraya
Obaid, director of the U.N. Population
Fund, noted, “It would cost the
world less than two and a half days’
worth of military spending to save
the lives of 6 million mothers, newborns
and children every year.”

The full text of this
article appears in the Summer issue of Ms. magazine, available on
newsstands or by joining the Ms. community at www.msmagazine.com.

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  • http://www.cmqcc.org invalid-0

    Thank you for your article. You are correct that political will is key to improving efforts and increasing resources to address maternal mortality. It is clear that we are in this together, even in rich resource countries.

    In California, US, the maternal mortality rate more than DOUBLED to 15.2 in 2003, from 6.7 in 1998. The first state wide maternal mortality review report will be forthcoming by the end of the year. The data show that >70% of these pregnancy-related deaths had some, good or strong chance of altering outcomes. People do not realize that in the US hospitals are not required to have obstetric hemorrhage protocols, or have their OB teams practice drills and teamwork that could save women’s lives.

    In the US we have the problem of OVER-use of technologies, such as cesarean and induction, which have increased dramatically in the past ten years. As a result, we see worse outcomes. Ironically, in countries such as Nigeria, there is a critical UNDER-use of technology. The correct ‘dose’ of technology, similar to correct dosing of medication, is essential to avoid unnecessary maternal deaths and serious complications.

    It may be that some less resourced community hospitals in CA would also benefit from having this anti-shock garment.

    Thank you for bringing this issue to our attention.
    Regards,
    Christine H Morton, PhD
    California Maternal Quality Care Collaborative
    http://www.cmqcc.org