Global a woman while pregnant or within

Maternal Health: Trend over time, Challenges and Opportunities


Part 1: Trend
over time of maternal mortality worldwide from 2000 to 2015

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            According to the World Health
Organization (WHO) 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.”.

            There has been a notable decline in
the number of women dying because of complications throughout their pregnancy period
and childbirth. This decline has been recorded to be from approximately 532,000
in 1990 to 303,000 in 2015 yielding a 43% total reduction. The progress is significant;
however, the annual rate of decline falls short of the Millennium Development Goal
(MDG) target of a 75% reduction between 1990 and 2015, which needs an annual
decline of 5.5% compared to the 43% decline since 1990 which translates into an
average annual decline of only 2.3%. It is worth mentioning that the global
maternal mortality ratio or MMR (number of women who die during pregnancy and
childbirth, per 100,000 live births) has decreased by 1.2% per year between 1990
and 2000 and the improvement accelerated to 3.0% decline between 2000 and 2015
(Alkema et al. 2016).

            One should take into consideration
that when interpreting MMR, it is rather easier to decrease MMR when the levels
are high than when they are low as this indicates that there has been
deployment of possible realistic solutions hence the low MMR. The highest decline
between 1990 and 2015 was recorded in Eastern Asia (72%), after that Southern
Asia and South-eastern Asia with a decline of 67% and 66% respectively,
Northern Africa (59%), Caucasus and Central Asia (52%), Oceania (52%), Latin
America and the Caribbean (50%), sub-Saharan Africa (45%) and Western Asia
(43%). The decline in developed regions was 48% (Alkema et al. 2016).

Part 2: Challenges
in reducing maternal mortality

            There are large disparities
between countries in terms of maternal deaths. This reflects the inequalities
in access to health services, and sheds the light on the gap between rich and
poor. Almost all maternal deaths (99%) occur in developing countries half of
them occur in sub-Saharan Africa and almost one third occur in South Asia (Patton
et al. 2099).

            On average, women in developing countries
tend to have many more pregnancies than women in developed countries hence
their risk of death due to pregnancy and childbirth complications is higher. For
example, in fragile states, the risk is 1 in 54; showing the consequences from
breakdowns in health systems. In Ghana in particular, according to (Kyei-Nimakoh
et al. 2016) the major maternal health challenges include: difficulties in
tracking of maternal deaths; midwifery workforce crisis; challenges in community-based
health services; poor transport and emergency response; and low skilled
attendance at birth. This has led to a slow progress towards reaching the MDG
target and therefore a MDG Acceleration Framework was initiated in 2010, by the
United Nations Development Programme and other United Nations’ agencies. This
program provides a systematic approach for countries not reaching the MDG
targets to pinpoint possible causes for the delay and identify tailored
solutions to fasten the progress (Kyei-Nimakoh et al. 2016).

            Moreover, one of the emerging
challenges in maternal mortality is the rising of the late maternal mortality
occurring more than 42 days, but less than one year following the pregnancy
termination. A phenomenon known to be part of the “obstetric transition” as
health systems are improving and are better able to handle immediate childbirth
complications and hence averting death within the first 48 hours, but not late
maternal sequelae (Souza et al. 2014). This trend has been observed in several
counties like Mexico and accounting for 15% of the overall maternal deaths
there (Souza et al. 2014). This highlights the importance of further analyses
of trends in maternal mortality between 1990 to 2015 to ensure accurate
documentation to identify shifting dynamics in maternal health.

Part 3: Innovations
strategies that could be to reduce maternal mortality

            The shamefully high numbers of maternal
deaths attracted intense scrutiny to reduce the numbers of women dying from
maternal causes. WHO has recently published strategies to help end preventable
maternal mortality. This includes a strategic framework that has 5 main objectives
which have been implemented by several countries and resulted in significant
reductions in maternal mortality.

Focusing on inequities in access
to and the quality of reproductive, sexual, maternal, and new-borns health
care.  For example, Ethiopia has
developed programs designed to specifically address social and structural
barriers pertaining to sexual, reproductive, maternal and new-born health in
addition to training health mangers on gender mainstreaming in the workplace as
published by the WHO the H4+ partnership: joint support to improve women’s and
children’s health progress report.

Providing universal health
coverage for an all-inclusive sexual, reproductive, maternal and new-born
health care. For example, Rwanda applied a community based health insurance
plan to ensure the access of vulnerable population to maternal and child health
services (Worley 2015).

Addressing all the causes related
to maternal mortality, reproductive and maternal morbidities, and other related
disabilities. For example, according to Nepal Ministry of Health and Population,
Nepal worked on increasing access to modern family planning services, and
increased literacy rates among girls and women which reflected back by
increased attendance frequency to family planning facilities.

Strengthening health care systems
to respond to women and girls needs and priorities. For example, Indonesia
invested in training midwives and creating a dedicated, community/village level
maternal health services delivery points (Van Lerberghe et al. 2014)

Ensuring liability and accountability
in data collection to improve the quality of health care and equality. For example,
Mongolia initiated procedures at the level of the facility, ministerial, and
provincial levels to confirm maternal deaths were recorded within 24 hours period
and transferred to the ministry of health for further review (Yadamsuren et al.