Delays Recognized in Maternal Mortality
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.
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