SUPPORTING HEALTHY AND EMPOWERED MOTHERS

A WOW! e-Brief

Work of Women program @ World Neighbors

May 2007

 

Overview

Motherhood should be a rewarding and fulfilling experience. But for far too many women, it is life-threatening. In fact, the period when women are most at risk of death is during pregnancy, childbirth and the month and a half following childbirth. A woman dies during pregnancy or childbirth every minute of every day throughout the year—more than 500,000 women a year.

This problem is overwhelmingly one of less developed countries. In fact, the map of maternal-related deaths is, for the most part, a map of poverty and marginalization. Maternal death is the health indicator that most clearly illustrates the result of differences between rich and poor countries. About 99 percent of the hundreds of thousands of women who die each year live in low-income countries. A woman living in an industrialized country faces a 1 in 4,000 lifetime risk of death during pregnancy or childbirth, while a woman living in eastern or southern Africa faces a 1 in 15 lifetime risk. In western and central Africa it is 1 in 16, and in South Asia it is 1 in 43.

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There are several ways of looking at this situation. From a medical view, the Population Reference Bureau lists the “direct causes” of 80 percent of maternal deaths in order from highest to lowest percentage as hemorrhage, infections, unsafe abortions, hypertensive disorders and obstructed labor. Other sources, such as the Global Health Council, list complications due to unsafe abortion as the leading cause of death. Because abortion is illegal or restricted in many countries, statistics are difficult to compile. However, experts assume that a significant percentage of the deaths from hemorrhage and infection are also results of unsafe abortions. Violence also plays a role in maternal deaths, though numbers are likely underreported. The remaining 20 percent of women die from existing conditions that are aggravated by pregnancy, such as malaria, anemia or diabetes.

Another way of understanding the large number of women dying during pregnancy and childbirth is to look at the overall health and context in which women experience pregnancy. Mothers, as women in general, often live with poor or precarious health due to poor nutrition, overwork, pregnancies that are spaced too close together, violence and lack of access to quality healthcare.

Public health professionals also link the high levels of death and disability to a variety of delays that women experience in accessing skilled care during pregnancy and childbirth. Approximately 15 percent of all deliveries have complications that require the care of a skilled professional like a doctor, nurse or midwife—but in developing countries women have the help of a skilled attendant for only about half of all deliveries. The delays in getting skilled care include (1) delays in recognizing that a condition is serious enough to require help, (2) delays in deciding to seek this help, (3) delays in getting to a treatment center due to distance or lack of transportation and (4) delays in starting treatment at a center due to lack of available skilled personnel or lack of access to drugs, blood or equipment.

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Death isn’t the only issue of course. For every woman who dies as a result of a pregnancy or childbirth related cause, 30 more suffer injury, infection or disability. These can be serious illnesses from which they eventually recover. They can also be conditions that worsen with each pregnancy and eventually lead to permanent disability or death. Obstetric fistula is just one of these conditions, but one that in some areas is devastating to women not only physically, but socially as well. An obstetric fistula is a hole that develops between a woman’s birth canal and her bladder or rectum as a result of prolonged, obstructed labor. This hole causes her to leak urine or feces, or both, and women often suffer in silence with the condition. The odor often also causes her to be ostracized within her family and community. Young women and girls whose bodies haven’t fully matured are more at risk for developing fistula.

The devastation of hundreds of thousands of unnecessary deaths of women and girls each year alone is enough for action. However, the loss of women in their role as mothers due to death and serious disability also has a profound effect on families, especially children. When mothers die, newborns are far less likely to survive and even children under 10 years of age are 10 times more likely to die than their counterparts who still have their mothers. The very women who are most at risk of death and disability related to pregnancy and childbirth are also the women who have the poorest overall health due to poor nutrition and pre-existing conditions that worsen during this period. Those situations also frequently cause their babies to get an unequal start—poorer overall health, lower resilience to illnesses and delayed physical and intellectual growth.

We already know about low-cost, low-tech solutions that work immediately to raise survival rates. We also know longer term ways to reduce women’s risk for death and disability linked to pregnancy and childbirth. In the following section, read more about ways in which World Neighbors integrates Safe Motherhood policies and practices into our health work, and other ways that we partner with communities  to reduce women’s vulnerability over the long term to life-threatening situations related to reproductive health.

Top photo by Linda Jo Stern.

 

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