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Delays Recognized in Maternal Mortality

  • Lubna Hassan
  • Lauren Woodbury
Chapter

Abstract

The past 25 years saw a global reduction in maternal deaths by 44%. However, over 800 women continue to die every day as a result of complications from pregnancy and childbirth, and most of these deaths are preventable. Notably, 99% of maternal deaths occur in the developing world (World Health Organization, Maternal mortality Fact Sheet No. 348, 2015). Though South Asia has made progress, it still has the second highest number of maternal deaths of any region. Hence, there is much left to be done, and in 2017 eliminating preventable maternal mortality is still a priority of health and development agendas. This is a crucial time for achieving this goal as it is a period of transition from the Millennium Development Goals, which ended in 2015, to the beginning of the more comprehensive Sustainable Development Goals. It is paramount that those working in health and development do not let progress stall.

Several key findings emerged from the global effort to achieve MDG 5 as well as from countries that have begun implementing Maternal Death Surveillance and Response (MDSR) systems. Central to these findings is the fact that preventing complications through regular and adequate antenatal care is more efficacious than treating complications as they arise. While important, the ability of the health-care provider to respond to complications through services collectively known as emergency obstetric care (EmOC) is not in and of itself enough to achieve global targets for maternal mortality reduction. Instead, the quality of care is paramount. Efforts to achieve “universal coverage” alone are not sufficient; if quality is not emphasized, women will continue to die of preventable causes.

The Three Delays Model is a useful framework for understanding the factors which prevent women and girls from accessing the health care they need. Delays can occur throughout the continuum of care including (1) a delay in seeking care, (2) delays in reaching care, and (3) delays in receiving care (Thaddeus S, Maine D, Soc Sci Med 38:1091–110, 1994). Many women fail to receive adequate care due to one or a combination of the three delays. There are well-known socioeconomic and cultural elements at play which contribute to the delays by impinging the status of women.

An integrated approach is necessary to address each of the issues women face when trying to access safe childbirth. Issues of inequity must be addressed to make universal coverage a reality, and quality of care must be emphasized. The OB/GYN community should lead the way in advocacy, training, and generally raising their voices wherever the rights of women are infringed. The OB/GYN community can play a key role in improving services in their own hospitals as well as pressuring governments to take responsibility for improving health systems at all levels.

References

  1. 1.
    Say L, Chou D, Gemmill A, Tunçalp O, Moller AB, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet. 2014;2(6):e323–33.PubMedGoogle Scholar
  2. 2.
    United Nations Human Rights Office of the High Commissioner. Preventable maternal mortality and morbidity and human rights. Retrieved from http://www.ohchr.org/Documents/Issues/Women/WRGS/Health/ReportMaternalMortality.pdf.
  3. 3.
    WHO. Strategies toward ending preventable maternal mortality (EPMM); 2015. http://www.everywomaneverychild.org/images/EPMM_final_report_2015.pdf. Accessed 7 July 2016.
  4. 4.
    Barnes-Josiah D, Myntti C, Augustin A. The “three delays” as a framework for examining maternal mortality in Haiti. Soc Sci Med. 1998;46(8):981–93.CrossRefGoogle Scholar
  5. 5.
    Rosenfield A, Maine D. Maternal mortality – a neglected tragedy. Where is the M in MCH? Lancet. 1985;2:83–5.CrossRefGoogle Scholar
  6. 6.
    WHO. Making pregnancy safer: the critical role of the skilled attendant. A joint statement by WHO, ICM and FIGO; 2004. http://www.who.int/maternal_child_adolescent/documents/9241591692/en/ Accessed 9 July 2016.
  7. 7.
    UNICEF. UNICEF Data: Monitoring the situation of children and women; 2016. http://data.unicef.org/maternal-health/maternal-mortality.html. Accessed 6 July 2016.
  8. 8.
    WHO. Global Health Observatory Data. State of inequality: reproductive, maternal, newborn and child health. Geneva: World Health Organization; 2015. http://www.who.int/gho/health_equity/report_2015/en Accessed 8 July 2016Google Scholar
  9. 9.
    WHO. Trends in maternal mortality: 1990 to 2013 Estimates by UNICEF, UNFPA, The World Bank, and the United Nations Population Division; 2014. http://apps.who.int/iris/bitstream/10665/112682/2/9789241507226_eng.pdf. Accessed 7 July 2016.
  10. 10.
    WHO. Trends in maternal mortality: 1990 to 2015, Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Fund; 2015. http://apps.who.int/iris/bitstream/10665/194254/1/9789241565141_eng.pdf. Accessed 7 July 2016.
  11. 11.
    Lancet. The Lancet. Women’s, children’s, and adolescents’ health needs universal health coverage. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01176-9/abstract.
  12. 12.
    Paily VP, Ambujam K, Rajasekharan Nair V, Thomas B. Confidential review of maternal deaths in kerala: a country case study. BJOG 2014;121(Suppl. 4):61–66.Google Scholar
  13. 13.
    WHO. Consultation on improving measurement of the quality of maternal, newborn and child care in health facilities; 2013. http://apps.who.int/iris/bitstream/10665/128206/1/9789241507417_eng.pdf. Accessed 7 July 2016.
  14. 14.
    WHO. 2016. Standards for improving quality of maternal and newborn care in health facilities. http://www.who.int/maternal_child_adolescent/documents/improving-maternal-newborn-care-quality/en/p.6.
  15. 15.
    WHO. 2016. Time to respond: a report on the global implementation of maternal death surveillance and response. http://apps.who.int/iris/bitstream/10665/249524/1/9789241511230-eng.pdf. Accessed 30 Mar 2017.
  16. 16.
    Mathur A, Awin N, Adisasmita A, Jayaratne K, Francis S, Sharma S, et al.Maternal death review in selected countries of South East Asia Region. BJOG 2014;121(Suppl. 4):67–67.Google Scholar
  17. 17.
    WHO. Maternal Death Surveillance and Response. http://www.who.int/maternal_child_adolescent/epidemiology/maternal-death-surveillance/en/. Accessed 7 July 2016.
  18. 18.
    Matsubayashi, T. et al. Analysis of cross-country changes in health services, Chapter 5. In: Peters D, et al. Improving health services in developing countries: from evidence to action; 2009.Google Scholar
  19. 19.
    El-Saharty, Sameh and Naoko Ohno. South Asia’s quest for reduced maternal mortality: what the data show. World Bank Group; 2015. http://blogs.worldbank.org/health/south-asia-s-quest-reduced-maternal-mortality-what-data-show.
  20. 20.
    The Partnership for Maternal, Newborn & Child Health; 2014. http://www.who.int/pmnch/knowledge/publications/2014_pmnch_report/en/. Accessed 30 July 2016.
  21. 21.
    WHO. Time to respond: a report on the global implementation of maternal death surveillance and response; 2016. http://apps.who.int/iris/bitstream/10665/249524/1/9789241511230-eng.pdf. Accessed 30 Mar 2017.
  22. 22.
    WHO. The world health report 2005—make every mother and child count; 2005.Google Scholar
  23. 23.
    WHO. WHO Recommendations on antenatal care for a positive pregnancy experience; 2016. http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/anc-positive-pregnancy-experience/en/. Accessed 26 Mar 2016.
  24. 24.
    WHO. Reducing maternal mortality. A joint statement by WHO/UNFPA/UNICEF/World Bank. Geneva; 1999. http://apps.who.int/iris/bitstream/10665/42191/1/9241561955_eng.pdf. Accessed 15 July 2016.
  25. 25.
    Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med. 1994;38(8):1091–110.  https://doi.org/10.1016/0277-9536(94)90226-7. Accessed 10 July 2016CrossRefPubMedGoogle Scholar
  26. 26.
    D. Maine. Safe motherhood programs: options and issues, Columbia University; 1991.Google Scholar
  27. 27.
    World Bank. Bangladesh - Reproductive health at a glance. Reproductive health at a glance; Bangladesh. Washington, DC: World Bank; 2011. http://documents.worldbank.org/curated/en/307361468212071971/Bangladesh-Reproductive-health-at-a-glance. Accessed 10 July 2016.
  28. 28.
    World Bank. Afghanistan - Reproductive health at a glance. Reproductive health at a glance; Afghanistan. Washington, DC: World Bank; 2011. http://documents.worldbank.org/curated/en/262581467996765917/Afghanistan-Reproductive-health-at-a-glance. Accessed 10 July 2016.
  29. 29.
    World Bank. Pakistan - Reproductive health at a glance. Reproductive health at a glance; Pakistan. Washington, DC: World Bank; 2011. http://documents.worldbank.org/curated/en/512941468325459864/Pakistan-Reproductive-health-at-a-glance. Accessed 10 July 2016.
  30. 30.
    World Bank. India - Reproductive health at a glance. Reproductive health at a glance; India. Washington, DC: World Bank; 2011. http://documents.worldbank.org/curated/en/743521468050934458/India-Reproductive-health-at-a-glance. Accessed 10 July 2016.
  31. 31.
    World Bank. Nepal - Reproductive health at a glance. Reproductive health at a glance; Nepal. Washington, DC: World Bank; 2011. http://documents.worldbank.org/curated/en/357801468289200282/Nepal-Reproductive-health-at-a-glance. Accessed 10 July 2016.
  32. 32.
    Sarkar J. Studies in Mughal India; 1919. https://archive.org/details/studiesinmughali00sarkuoft. Accessed 6 July 2016.
  33. 33.
    Chaghtai M.A. Le Tadj Mahal D’Agra (Hindi). Brussels; 1938.Google Scholar
  34. 34.
    World Health Organization. Maternal mortality Fact Sheet No. 348. Updated November 2015.Google Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  • Lubna Hassan
    • 1
  • Lauren Woodbury
    • 2
  1. 1.Women’s Health Intervention and Development Initiative (WHI-DI)The Woman’s Hospital, and SAFOG MNH CommitteePeshawarPakistan
  2. 2.WHI-DIPeshawarPakistan

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