As we start to count down the last year of the Millennium Development Goal (MDG) Challenge, we should celebrate the positive change associated with MDG5: improving maternal health. Since 1990, the world has experienced an incredible 47% decline in the rate of maternal mortality. However, many countries will not reach MDG5.
MDG5 is measured by two factors: achieving universal access to reproductive health for all women by 2015 and cutting the rate of maternal death by three-quarters between 1990 and 2015. Many countries have made remarkable progress, like several sub-Saharan African countries, which have halved their maternal mortality rates since 1990. Yet, the area still accounts for half of all maternal deaths globally.
Every minute, a woman still dies during pregnancy or childbirth. That’s half a million unnecessary deaths every year. According to the WHO, a woman’s ‘lifetime risk of maternal death’, or the probability that a 15 year old will eventually die from maternal complications, is 1 in 160 in developing countries, while it is only 1 in 3700 in developed countries. But this is not just a third world problem. Although maternal mortality has dropped 3.1% on average since 1990 in the developed world, the United States faces a 1.7% increase in the rate of pregnancy-related deaths, jumping from 12.4 deaths per 100,000 in 1990 to 18.5 in 2013, meaning more women are dying of avoidable causes now.
These rates are unacceptable, especially because these deaths are almost entirely preventable. Prioritizing maternal health should be at the forefront of our post-2015 agenda. Nearly two out of three women located in rural areas of developing communities will never interact with their country’s formal health care system, and more than one-third of all births will take place without the assistance of a skilled birth attendant. By investing in new, creative solutions, including improving supply-chain management and expanding the network of frontline community health workers, we can connect isolated women to the care they need, and help all countries achieve MDG5.
Midwives and skilled birth attendants have played an integral role in the success of the countries that have shown positive change. Midwives can reach women to provide prenatal and post-partum care in their own homes and on their own terms, as well as help to mitigate risk during childbirth. Midwives also provide needed family planning programming and education to help women time and space births for when they are physically ready and able to care for their children. They are often the only link many families have to health care, providing HIV tests, contraception, and vaccinations to their patients, as well. Most importantly, midwives are trusted members of the communities they serve and well-versed in the cultural norms of their patients.
There is no reason for a woman to die during childbirth of controllable factors. The UNFPA estimates that just 350,000 more trained midwives would ensure that all women have safe pregnancies and deliveries. We must provide opportunities for midwifery training and easy access to supplies for their services. Policies to improve coordination, communication, and collaboration between these frontline health workers and the more formal public health hospital system should be the priority of every country experiencing high maternal mortality. And communities should work to support the work of midwives to ensure motivation and retention, especially in more rural areas.
This goal, in particular, serves an integral role in accomplishing the other seven MDG’s, including reducing child mortality (MDG 4), achieving universal primary education (MDG2), promoting gender equality and empowering women (MDG 3), eradicating extreme poverty and hunger (MDG 1), and arguably the rest, as well. Investing in a mother’s health has reverberating impact in the health of her child, not only for the healthy development of the newborn, but to ensure her survival to care for the child. Concentrating resources to support midwives, as a proven strategy to tackle maternal mortality, should be a focal point of the post-2015 agenda. Doing so would save hundreds of thousands of lives, maternal and newborn.
To access the 2014 Midwifery Toolkit to advocate for the improved availability, accessibility, acceptability, and quality of midwifery services in your country, click here.