Maternal, newborn, child and adolescent health

Cover our mothers and babies

By Margaret Chan, Thoraya Obaid, Joy Phumaphi and Ann M. Veneman

GENEVA: An ancient African proverb states: Giving birth is like crossing a narrow bridge. You can walk to the bridge with someone. You can have someone meet you at the other side. But you have to cross that bridge alone.

Today, numerous pregnant women, the world over, are forced to go it alone with tragic consequences. They do not have access to the care they need or cannot afford it. They live far away from health facilities and cannot reach them. For some of those who do make it to a health centre, there is no doctor, midwife, drugs or equipment. Millions cannot plan their families as they wish and have to cope with unwanted pregnancies.

Giving the precious gift of life amounts paradoxically to a death sentence for far too many. Worldwide, every minute a woman dies due to complications during pregnancy and childbirth. This adds up to more than half a million women's lives lost every year with little improvement since 1990. At the same time, four million newborns die every year.

Nearly all maternal deaths take place in developing countries. In Niger, for example, a woman has a one in seven risk of dying due to complications of pregnancy and childbirth during her reproductive years. By contrast, in Sweden, the lifetime risk of dying from these causes is much lower at one in 17 400. More than 60% of newborn deaths occur in just ten developing countries in Africa and Asia.

In developing countries, pregnancy and childbirth are the leading cause of death among women of reproductive age. Maternal death mainly affects poor, rural women.

These grim statistics do not have to be that way. Most maternal and newborn deaths are entirely preventable. We have just met with leaders at the United Nations General Assembly special summit on progress achieved so far on the Millennium Development Goals. We know only too well that Goals 4 and 5 on improving maternal and newborn and child health are the MDGs least likely to be met in virtually all regions of the world. At this crucial halfway point to the 2015 MDGs, we intend to do everything in our power to improve this dismal situation.

Two decades of stagnation in reducing maternal mortality is unacceptable. In addition, there is a significant price associated with maternal and newborn death estimated at US$ 15 billion in lost productivity. This is a cost that the most-affected societies cannot afford.

On the other hand, if we protect the right to health of women, mothers and their children, we are building viable families, communities and nations, with clear economic benefits.

There is a strong international consensus about what needs to be done. This is reflected in the internationally-agreed targets on maternal health and universal access to reproductive health. We need to turn these commitments into effective action.

Immediate action to cut maternal deaths can be taken by making available skilled health professionals for births and providing emergency obstetric care if complications arise during pregnancy or delivery. There are just five main direct causes of maternal death: severe bleeding, infections, complications from unsafe abortion, high blood pressure-related disorders, and obstructed labour. The largest number of women die because they bleed to death. Newborns die from equally preventable causes such as asphyxia, neo-natal tetanus, and low-birth weight.

Effective family planning can play an important role in the reduction of maternal and child mortality: up to 100 000 maternal deaths could be avoided each year if women who want to postpone or prevent a pregnancy used it.

Finally, charging disadvantaged women for essential childbirth services discourages their use. Reduction or removal of user fees incentivizes such women to come forward. In addition, providing timely transportation to well-equipped health facilities for rural women or, alternatively, bringing good care close to home is key.

Stopping maternal and newborn deaths is a huge challenge. Ideally, all the critical elements of a well-functioning health system — financial protection, trained staff, conveniently located, well-stocked primary health care and facilities — must be in place. Available resources need to be multiplied thirty-fold, by both the international community and affected countries. Deep-rooted norms and behaviours contributing to the low status of women and their disempowerment need to be shifted.

No woman should have to cross the proverbial bridge of childbirth alone.

Dr Margaret Chan is Director-General of the World Health Organization.
Thoraya Ahmed Obaid is Executive Director of the United Nations Population Fund.
Joy Phumaphi is the World Bank's Vice President for Human Development, and Chair of the Partnership for Maternal, Newborn, and Child Health.
Ann M. Veneman is the Executive Director of the United Nations Children's Fund.