Source: E-mail dt. 2 April 2015
Women and Maternal health
K. Praveena, Lecturer, Department of Economics,
Thiagarajar College, Teppakulam, Madurai – 09.
Reproductive health is defined as a state of physical, mental, and social well-being in all matters relating to the reproductive system, at all stages of life. Good reproductive health implies that people are able to have a satisfying and safe sex life, the capability to reproduce and the freedom to decide if, when, and how often to do so. Men and women should be informed about and have access to safe, effective, affordable, and acceptable methods of family planning of their choice, and the right to appropriate health-care services that enable women to safely go through pregnancy and childbirth. Reproductive Health has a particular interest on the impact changes in reproductive health have globally, and therefore encourages submissions from researchers based in low - and middle-income countries.
Within the framework of WHO's definition of health as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, reproductive health addresses the reproductive processes, functions and system at all stages of life. Reproductive health, therefore, implies that people are able to have a responsible, satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so.
Implicit in this are the right of men and women to be informed of and to have access to safe, effective, affordable and acceptable methods of fertility regulation of their choice, and the right of access to appropriate health care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant.
Maternal health is the health of women during pregnancy, childbirth, and the postpartum period. It encompasses the health care dimensions of family planning, preconception, prenatal, and postnatal care in order to reduce maternal morbidity and mortality. Preconception care can include education, health promotion, screening and other interventions among women of reproductive age to reduce risk factors that might affect future pregnancies.
The goal of prenatal care is to detect any potential complications of pregnancy early, to prevent them if possible, and to direct the woman to appropriate specialist medical services as appropriate. Postnatal care issues include recovery from childbirth, concerns about newborn care, nutrition, breastfeeding, and family planning.
In 2013, about 800 women died due to complications of pregnancy and child birth every day. Almost all of these deaths occurred in low-resource settings, and most could have been prevented. The primary causes of death are haemorrhage, hypertension, infections, and indirect causes, mostly due to interaction between pre-existing medical conditions and pregnancy. The risk of a woman in a developing country dying from a maternal-related cause during her lifetime is about 23 times higher compared to a woman living in a developed country. Maternal mortality is a health indicator that shows very wide gaps between rich and poor, urban and rural areas, both between countries and within them.
Maternal Death is defined as "The death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes."
The number of maternal deaths in 2013 was 293,000 down from 377,000 in 1990. The top causes of death are: post partum bleeding (15%), complications from unsafe abortion (15%), hypertensive disorders of pregnancy (10%), postpartum infections (8%), and obstructed labour (6%)
Causes of Maternal death
Factors that increase maternal death can be direct or indirect. Generally, there is a distinction between a direct maternal death that is the result of a complication of the pregnancy, delivery, or management of the two, and an indirect maternal death. that is a pregnancy-related death in a patient with a preexisting or newly developed health problem unrelated to pregnancy. Fatalities during but unrelated to a pregnancy are termed accidental, incidental, or nonobstetrical maternal deaths.
The most common causes are post partum bleeding (15%), complications from unsafe abortion (15%), hypertensive disorders of pregnancy (10%), postpartum infections (8%), and obstructed labour (6%). Other causes include blood clots (3%) and pre-existing conditions (28%). Indirect causes are malaria, anaemia, HIV/AIDS, and cardiovascular disease, all of which may complicate pregnancy or be aggravated by it.
Sociodemographic factors such as age, access to resources and income level are significant indicators of maternal outcomes. Young mothers face higher risks of complications and death during pregnancy than older mothers, especially adolescents aged 15 years or younger. Adolescents have higher risks for postpartum hemorrhage, puerperal endometritis, operative vaginal delivery, episiotomy, low birth weight, preterm delivery, and small-for-gestational-age infants, all of which can lead to maternal death. Structural support and family support influences maternal outcomes. Furthermore, social disadvantage and social isolation adversely affects maternal health which can lead to increases in maternal death. Additionally, lack of access to skilled medical care during childbirth, the travel distance to the nearest clinic to receive proper care, number of prior births, barriers to accessing prenatal medical care and poor infrastructure all increase maternal deaths.
Unsafe abortion is another major cause of maternal death. According to the World Health Organization, every eight minutes a woman dies from complications arising from unsafe abortions. Complications include hemorrhage, infection, sepsis and genital trauma. Globally, preventable deaths from improperly performed procedures constitute 13% of maternal mortality, and 25% or more in some countries where maternal mortality from other causes is relatively low, making unsafe abortion the leading single cause of maternal mortality worldwide.
Measures to control maternal death
Women must have access to skilled care before, during and after they give birth.
1. Health providers must be trained in emergency obstetric care. Health centers and clinics must have surgical supplies to handle complications.
2. Maternal health-care systems must be strengthened, and communities mobilized and educated to improve deliveries in birth clinics.
3. Skilled community-based birth attendants should be trained and posted to increase maternal coverage in remote areas.
4. Give incentives to health providers to motivate them to do their job effectively.
5. Contract with private organizations to deliver maternal health-care services. This will ensure rural areas are covered and will reduce supply shortages–but attention must also be paid to the quality of service provided.
6. Educate and empower women and girls about maternal health issues. They compose two-thirds of the world’s illiterates and 70 percent of the world’s poorest people. Educated and empowered women can lead healthy lives and can lift their families out of disease. They usually marry later, and have fewer and healthier children who are more likely to attend school.
7. Empower women’s groups so they can deliver political success and tangible health outcomes.
8. Launch professional, well-informed advocacy groups to call for action on maternal health.
9. Implement streamlined and evidence-based maternal health interventions.
10. Implement evidence-based strategies to increase utilization of maternal health-care services.
11. Remove user fees for maternal health care services and provide transportation services to maternal health centers–which alone can double the utilization of the centers’ services.
12. Evaluate and monitor maternal and child health policies.
13. Make sure that the appropriate government ministries are accountable to the public about the performance of investments in maternal health.
14. Create strategic alliances between groups representing maternal health, as those will open doors to political and financial support. Currently, maternal health communities have many leaders but no leadership.
15. Make child and maternal survival a core national and global health concern.
Implementing the above strategies is not only the right thing to do, it is the economically smart thing to do. Women and girls are a driving force in our economies, and when women are healthy, they play a crucial role in the development of countries.
Young women especially, have lifetimes of potential economic returns to give to their communities. Globally, maternal and infant deaths account for $15 billion in lost productivity, not to mention immeasurable grief for families and communities. That is $15 billion that could instead go towards strengthening economies, building roads and schools and fostering a brighter future for our children.
In many developing countries, more than a third of pregnant women have no access to or contact with health professionals before they deliver. The assistance of skilled attendants who are trained to identify and manage complications and refer patients to emergency obstetric care if needed can literally mean the difference between life and death for both woman and child.
But skilled attendants can only be effective when they work in the context of functional health systems. Many health facilities desperately need vital medical supplies such as antibiotics, uterotonics (i.e., oxytocin or misoprostol) and magnesium sulfate for eclampsia; safe blood supplies; upgraded facilities; and better transportation services to emergency obstetric care. And for women who give birth outside of health facilities, increasing access to life-saving technologies such as misoprostol and the non-pneumatic Anti-Shock Garment for postpartum hemorrhage can save lives.