Not enough or too much: Getting health-care right to save women’s lives
15 September 2016: The poorest and most marginalized women continue to face the highest risk of death from causes related to pregnancy and childbirth. The authors of a special series published in The Lancet today, warn that efforts must be drastically increased to safeguard the maternal health of all women everywhere, if the good health and well-being of all people – and in turn the well-being and prosperity of communities and societies – are to be achieved.
Three days before giving birth, a woman walks behind her husband to a primary health centre, India.
UNICEF/Khemka
WHO estimates that 830 women die every day from preventable causes related to pregnancy and childbirth. Considerable progress has been made on a global level to reduce maternal mortality – between 1990 and 2015, maternal mortality worldwide dropped by about 44%. The authors of The Lancet series note however, that at regional and national levels progress has been ‘patchy’, and that in some countries the pace of improvement appears to be slackening.
Diversity and difference
An article published in The Lancet series, which chiefly examines data on maternal mortality and morbidity, highlights how inequalities in maternal health are becoming more diverse and uneven, both within and between populations and countries. The authors note the importance for countries to recognize this uneven distribution of poor maternal health to ensure effective planning and implementation of actions to improve health. This includes the need to address inequities in wealth, socio-economic status, human rights and access to health-care.
Families wait near a refugee transit camp for refugees and migrants, Greece.
UNICEF/Georgiev
"Even in high-income countries, poorer and marginalised women face a higher risk of death during pregnancy and childbirth".
Doris Chou, Medical Officer, WHO and a co-author of the study
Doris Chou, Medical Officer at WHO and a co-author of the study comments, “Even in high-income countries, poorer and marginalised women face a higher risk of death during pregnancy and childbirth. This includes refugee and migrant women who may not have the legal status required to access the health-care they need. More needs to be done by all countries across the world to address the inequalities in health-care provision, quality and access – maternal health is a major indication of countries’ progress in the post-2015 era of the Sustainable Development Goals”
Too little, too much
Another article published as part of The Lancet series, further highlights this growing diversity and difference in maternal health, in relation to the nature and quality of health-care given to women during pregnancy and childbirth. It compares two extreme situations in maternal health-care provision: one which the authors term ‘too little, too late’, and the other ‘too much too soon’.
‘Too little too late’ refers to inadequate provision of health-care, including care with insufficient resources, poor quality care given with below-evidence standards, or care which is withheld or unavailable until it is too late. This often applies in low- and middle-income countries, which have seen a push towards births in facilities which have inadequate and poorly trained staff, insufficient infrastructure and commodities, and a lack in evidence-based practice. This can often result in poor quality care that puts women and girls lives at greater risk during pregnancy and childbirth.
‘Too much too soon’ refers to the unnecessary use of interventions which are not based on evidence, as well as the use of interventions which have the potential to be life-saving when used appropriately, but harmful when applied routinely or used too much. This situation, characterised by excessive medicalization, is becoming more widespread in middle-income countries, and is associated with disrespect and abuse of women in health-care facilities.
Joshua Vogel, Technical Officer at WHO and a co-author of the study notes, “In all countries and contexts, it is crucial that health-care providers adhere to evidence-based recommendations that ensure good quality, timely and respectful care.”
WHO response
WHO/PAHO
“Maternal death is a burden carried by all societies and countries across the world, and is a reflection of poor health-care as well the neglect of human rights. Countries need to do more to ensure that all women, particularly those who are poorer and marginalised, have access to good quality health-care throughout the periods of pregnancy and childbirth.”
Ian Askew, Director of WHO Department of Reproductive Health and Research which includes the Human Reproduction Programme,
Improving maternal health is one of WHO’s key priorities. WHO works to contribute to the reduction of maternal mortality by increasing research evidence, providing evidence-based clinical and programmatic guidance, setting global standards, and providing technical support to Member States.
In addition, WHO advocates for more affordable and effective treatments, designs training materials and guidelines for health workers, and supports countries to implement policies and programmes and monitor progress.
Global Strategy for Women’s, Children’s and Adolescents’ Health
During the United Nations General Assembly 2015, in New York, UN Secretary-General Ban Ki-moon launched the Global Strategy for Women's, Children's and Adolescents' Health, 2016-2030. The Strategy is a road map for the post-2015 agenda as described by the Sustainable Development Goals and seeks to end all preventable deaths of women, children and adolescents and create an environment in which these groups not only survive, but thrive, and see their environments, health and wellbeing transformed.
Извор: Светска здравствена организација - 15.09.2016
