Delivering Better Maternal Care to the World

Maternal mortality is a global problem and it needs a global solution, therefore a collective action is very vital and urgent. It is not only a problem of the developing world but for the whole globe. Facts are clear, the United States ranks near the bottom of the world's wealthy countries when it comes to the number of women who die from complications of pregnancy and childbirth, according to new data from the World Health Organization. American women die in pregnancy or childbirth more than twice as often as women in Canada. Even worse, the United States is one of only a few countries-including Zimbabwe and North Korea-where the mortality rate has risen since 2000.

In the U.S., 14 out of every 100,000 mothers died due to complications of pregnancy or childbirth. That puts it between Qatar (13 deaths) and Bahrain (15) in the ranking of all 184 countries for which the WHO has data. The United States is ranked 46 out of those 184 countries, barely in the top 25 percent. By contrast, in Canada only 7 out of100, 000 mothers died in pregnancy or childbirth. American women are over four times as likely to die in pregnancy or childbirth as women in Greece, Iceland or Poland, where the rate is 3 out of every100,000. It is plainly true that United States is one of the world's wealthiest countries, and it spends way more on healthcare than other rich nations. So how did it end up here?

For starters, you can see parallel trends in America's infant mortality rate relative to other countries, too. Part of it is access to quality health care: poor American moms have less access to care, and may not even be covered by insurance at all. This isn't the case in many other countries, where health-care access is universal. So in the United States, the mothers who need care the most may be getting the least of it, which naturally leads to higher maternal mortality rates. I know a dear friend in the US, may hesitate to agree with these facts, but they are incontrovertible! I am referring to one golden-hearted lady who has dedicated most of her time sharing her life with lifeless, voiceless and vulnerable children! Yes, we can do great things on this earth, and small things with great love but I wonder how many lives this lovely lady has protected - this beacon of hope - one Lisa Kreiner - a single mother who works at an Orthodontic Dental Office in Frederick, Thurmont, Maryland USA. She is also part of the wonderful organization - Dress a Girl around the World, doing all kinds of charities they could lay their hands on, to make a difference in the little girls' lives. Next time, Mrs Lisa Kreiner, you are going to be asked by the helpless mothers to sell more Scentsy in order to fundraise for them as a way of bailing them out of this problematic situation. And being a star consultant, you will organise many scentsy open house parties in a view that kindness is the language which the deaf can hear and the blind can see.

There's a similar dynamic at work in other health outcomes, too --like life expectancy, for instance, where the United States is a huge outlier compared to other countries.
On the other hand, maternal mortality in the United States is a drop in the bucket compared to rates seen in some very poor countries. In Rwanda, for instance, the rate is 290 out of 100,000 -- 20 times the U.S. rate. The rate in Mali is 587 per 100,000, and in Sierra Leone it's an astonishing 1,360 out of 100,000. In that country, one mother dies for every 100 children born. Maternal deaths related to childbirth in the United States are nearly at the highest rate in a quarter century, and a woman giving birth in America is now more likely to die than a woman giving birth in China, according to a new study.

On the other hand, having a baby is hard in Africa: women walk a lot, and wait a lot! In Sub-Saharan Africa, just over 80% of the population lives in rural areas, But it's impossible to think about maternal health without thinking about the time and distance between where women live in rural areas and where the government constructs health facilities: health posts, health centres and hospitals. The three make up a primary health care unit as by Africa health vocabulary. According to the WHO in 2016, Africa's maternal mortality is highest in the world-The number of women dying from pregnancy complications has kept rising in Africa, from 870 per 100 000 expectant women in 2001 to 1000 in 2014. This therefore means that the maternal mortality rate in Africa is the highest in the world. The risk to a woman of dying in pregnancy or labour in Africa remains unacceptably high. For instance, In Zimbabwe the number of women dying from pregnancy-related complications has nearly trebled over the past decade from 253 to more than 700 per 100 000 pregnant women. Most of the deaths have been due to poverty, HIV/Aids, shortages of qualified health personnel, poor health facilities, delays in reaching health facilities because of shortage of transport and lack of medical resources. Illiteracy and lack of knowledge on pre-natal care, are some of the reasons for the rise in deaths. Many African countries have been hit by an exodus of medical personnel to overseas destinations in recent years. It is of little wonder therefore, that only 42% of births in the African region are attended by skilled personnel. Unsafe abortions are high among adolescents.

African governments' health budgets were also identified as inadequate to deal with obstetric cases. The percentage of GDP (gross domestic product) devoted to health in sub-Saharan Africa remains at between one percent and 3,7% compared to the large percentage spent on arms, which is also worrying.
The current emphasis on skilled attendants as a means to reduce maternal mortality contributes to a discouraging policy environment for traditional birth attendants (TBAs). They continue to attend a significant number of births, however, such that their role and the policies and practices affecting their work remain important to understanding maternity health care and maternal health in the global South.

Worse still, every year just over 500,000 women die from complications in pregnancy and childbirth across the world. Another 20 million experience severe complications. But many of these complications are entirely avoidable - including obstructed and protracted labour and one of its side-effects, obstetric fistula. An obstetric fistula is a hole in the birth canal between the vagina and the rectum or between the vagina and the bladder that is largely caused by obstructed and prolonged labour. This can occur when the mother's pelvis is too small or the baby is too large.

In sub-Saharan Africa for every 100,000 deliveries there are about 124 women who suffer an obstetric fistula in a rural area. Obstetric fistulas predominantly happen when women do not have access to quality emergency obstetric-care services. Antenatal care could help to identify potential problems early but will not have an impact if there is no skilled surgeon to assist with the labour. Although skilled attendants are necessary, it is the emergency obstetric surgeon who is needed to successfully remove the foetus and save both the baby and mother's life. This has proved to be a developing world problem. Obstetric fistulas are more commonly reported in developing countries, most of them in sub-Saharan Africa, including South Africa. But it is predominantly localised to the "fistula belt" - an area spanning the northern half of sub-Saharan Africa from Mauritania to Eritrea, and the Middle East and Asia's developing countries.


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