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Division of
Reproductive Health
(Technical Support)

World Health
Organization

CH-1211 GENEVA 27
SWITZERLAND

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En français

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Safe Motherhood As a Vital
Social and Economic Investment

(WHD 98.02)

Making motherhood safe for the world's women calls for national governments, multi-lateral and bilateral agencies and non-governmental organisations (NGOs) to make maternal health a top priority and to ensure that the necessary political and financial resources are dedicated to this effort. Safe motherhood is a vital, compelling and cost-effective economic and social investment. Promoting women's health improves not only individual health, but also the health and survival of women's families, the labour force and the well-being of communities and countries.

A series of recent international conferences defined reductions in maternal mortality and provision of pregnancy care as central objectives for all reproductive health services. Making maternal care a priority for a nation's economic and social health agenda will help ensure that millions of women and their children avoid the pregnancy-related death and disability that are still all too common. Over the next ten years, progress toward acknowledgement of safe motherhood as a key social and economic investment will be critical to achieving the goals of the Safe Motherhood Initiative.

 

The Consequences of Poor Maternal Health

The burden: For women of reproductive age, pregnancy and childbirth are the leading causes of death, disease and disability, accounting for at least 18% of the global burden of disease in this age group. Recent studies in four developing countries suggest that:

  • 58 to 80% of pregnant women developed acute health problems; of whom
  • 8 to 29% went on to develop chronic health problems as a result of pregnancy.1

The costs: While the needless suffering and death of a woman when giving life to the next generation is sufficient cause for action in itself, there are also other significant social and economic considerations. When a woman dies, her family and community are considerably less well off in economic and social terms. Specifically:

  • families lose her contribution to household management and provision of care for children and other family members;
  • the economy loses her productive contribution to the work force;
  • communities lose a vital member whose unpaid labour is often central to community life;
  • children suffer most: when a mother dies, surviving children are 3 to 10 times more likely to die within two years than children who live with both parents; motherless children are likely to get less health care and education as they grow up.

Women's wages and work within the home ­ both of which are dependent on women staying healthy ­ are increasingly important. In addition, the number of female-headed households is rising throughout the world. Already, 20% of households in Africa and Latin America are headed by women, and most include young children. Studies have shown that women are more likely than men to spend their own income on improving family welfare, through additional food, health care, and school supplies and clothing for young children.

 

What Is Saved by Investing in Maternal Health?

Reproductive health programmes, including maternal health, are among the most cost-effective investments in health. Providing women in low-income countries with antenatal, postpartum and delivery care, along with family planning, would cost about $3 each year per person. In Africa and some parts of Asia, the cost may be closer to $1, or even less. Investing in women's health yields significant savings:

Infant and Child Health:

  • Poor care of the mother often means death of the child; even if the mother survives, poor maternal health jeopardizes a newborn's chances of survival. At least 30 to 40% of infant deaths ­ 1.5 to 2.5 million each year ­ could be avoided with antenatal and delivery care. An estimated 75% of perinatal deaths, currently 7.5 million each year in developing countries, could be avoided with improved maternal health, adequate nutrition during pregnancy and appropriate management of deliveries.
  • Poor maternal health and nutrition contributes to low birth weight infants. Each year, 20 million low birth-weight babies are born ­ 20% of all births. Babies born under-weight die at significantly higher rates than those of normal weight, and are at greater risk for infection, malnutrition and long term disabilities, including visual and hearing impairments, learning disabilities and mental retardation.
  • A mother's death makes survival and education uncertain for her children. A study in Bangladesh found that a mother's death sharply increased the chances that surviving children up to age 10 will die within two years; this is especially true for daughters. When mothers die in childbirth, surviving children are less likely to complete their education, or attend school regularly. In Tanzania, a study found that in households where an adult woman had died during the previous 12 months, children spent half as much time in school as children from households where an adult woman had not died. The impact on children's survival and education was not significant when an adult male had died.

Productivity and Poverty:

  • Healthy women mean fewer poor women. Women are at the forefront of household and community efforts to escape poverty and cope with its impact. When women become sick, they cannot work in the home or in the paid labour force. In India, a study found that the female labour force would be about 20% higher if women's health problems were addressed. In addition, costs accociated with pregnancy-related health problems can lead women and families into debt.
  • Illness reduces productivity. At least 60% of pregnant women in the developing world are anaemic which reduces their energy and capacity for work ­ and can thus depress their incomes. Studies in Sri Lanka and China among women tea plantation and mill workers have documented reduced productivity due to anaemia ­ and the positive impact of iron supplementation.
  • Female poverty means household poverty. When disease and disability reduce women's capacity for work and earning an income, families inevitably suffer. Without women's income, there is less money available for children's health care, education and additional food.

Long-term impacts:

  • Prevention can be cost-effective. Reducing unwanted pregnancies and improving maternal health saves millions of women from premature death and long-term disability ­ and can save families and governments the costs of health care.
  • Strengthening maternal health services benefits the health system. Ensuring that a health facility is equipped to provide essential obstetric care, such as blood transfusions, anaesthesia and surgery, means that it can also provide care for accidents, trauma and other medical emergencies. This treatment capacity benefits the whole community, not just women.
  • Building women's trust promotes preventive care. Women who receive good care during pregnancy and childbirth are more likely to put their trust in other health services for themselves and for their family. As a result, they will use them to ensure children's health, and for family planning and other reproductive health services, including treatment of sexually transmitted diseases. Improved women's health means better family and community health.
 

What Can Be Done

Even in low resource settings, improving maternal health is possible. What is needed is a strong political commitment. Governments, international agencies, NGOs and other funders need to make concerted efforts to safeguard maternal health, and the social and economic benefits it provides, by:

  • reallocating investment in health care to support the most cost-effective interventions;
  • investing in maternal health care services and making them available, especially in poor and rural areas;
  • strengthening the capacity of community health centres and district hospitals to provide needed care, especially for obstetric complications, through staff training and provision of equipment;
  • working with private providers to expand and improve safe motherhood services, for example, by mandating that insurance policies include such care;
  • encouraging for-profit providers to provide free or low cost care to those who can't afford to pay;
  • supporting NGOs and voluntary organisations that may be able to mobilise private and community support for delivering services to underserved or disadvantaged women.

Strong and sustained government commitment, partnerships among nations, NGOs and multilateral institutions, and well-targeted investments can save millions of lives annually:

  • the 585,000 women who die from pregnancy-related causes;
  • the 1.5 to 2.5 million infants who die in the first week of life; and
  • the 1.4 million infants who are stillborn
 

Footnotes:

1. A. Tinker, "Safe Motherhood as an Economic and Social Investment". Presentation at Safe Motherhood Technical Consultation in Sri Lanka, 18-23 October,1997.

 

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