Source: E-mail dt. 2 April 2015
Women and Maternal health
K. Praveena,
Lecturer, Department of Economics,
Thiagarajar College, Teppakulam,
Madurai – 09.
Introduction
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
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.
Maternal
mortality
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
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.
Key facts
Conclusion
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.
References
1. http://www.who.int/topics/reproductive_health/en/
2. http://www.who.int/gho/maternal_health/en/
3. http://en.wikipedia.org/wiki/Maternal_death
4. http://msmagazine.com/blog/2010/07/28/16-ways-to-reduce-maternal-mortality/
5. https://www.arhp.org/publications-and-resources/contraception-journal/february-2011