Global Maternal Health - Literature review Example

Global Maternal Health In spite of the fact that the measurement of maternal health is an important point of discussion and developmental aspiration, it is often difficult to measure the variables attached to the equation especially in countries where not all mother receive maternity care in health units. Moreover, even in such healthy units record keeping is usually poor thereby making documentation and record retrieval on maternal morbidity and mortality a difficult prospect. And yet there are the areas where information related to the magnitude and possible cause of maternal mortality would be urgently required for policy making and action towards prevention. Maternal death is defined as the death of a woman while pregnant or within forty two days of termination of pregnancy, irrespective of the duration and the size of pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes (WHO Report, 1997). A clear definition of maternal morbidity is not always clear especially with respect to abortion related deaths. Nations Millennium Development Goal 5 – to reduce maternal mortality by 75 percent and to achieve universal access to reproductive health services by 2015 has made the least progress of all MDGs (WHO Report, 2005). At the global level, maternal mortality decreased by less than 1 percent per year between 1990 and 2005 – far below the 5.5 percent annual improvement needed to reach the target At this rate, MDG 5 will not be met in Asia until 2076 and many years later in Africa (WHO Report, 2004). Although maternal mortality has declined dramatically in the developed world, the risk of such death remains a serious threat for women in much of Asia, Latin America, and Africa, particularly in rural setting (Mavalankar and Rosenfields, 2005). The World Health Organization (WHO) estimates that 515 000 women die each year from pregnancy related causes, and almost all of these deaths occur in developing countries. The maternal mortality ratio for Africa is approximately 1000 per 100000 live births, compared to 8 to 12 per 100 000 live births in North America. Evidence gathered on Interventions. This situation is particularly tragic because no new technologies or drugs are needed to radically lessen maternal mortality. Rather, we believe that widespread access to emergency obstetric care (EmOC), and more generally to community-based and hospital maternity care services, would lead to dramatic reductions in these unacceptably high ratios. Significant declines in maternal mortality in Sri Lanka and Malaysia over the past 50 to 60 years provide evidence that the implementation of maternal health interventions in developing countries is feasible. Increased access to skilled birth attendance accompanied by the development of EmOC and other complementary health services were key contributors to the reductions achieved in those countries. Interventions with respect to dealing with maternal mortality could be understood in a variety of manners. Where interventions are concerned most quasi experimental studies have found a decline in maternal deaths following implementation of the intervention (Ross, Simkhada and Smith, 2005). The first instance is that of the low cost, high use of technology based interventions that are designed to have immediate effects. Interventions could have results such as (Sibley and Armbruster, 1997): 1. Increased proportion of timely referrals, from the decision to refer to arrival at the health facility 2. Increased proportion of TBA or village midwife-accompanied referrals. Increased proportion of families having a ready action plan for transportation. 3. Increased proportion of communities having a ready action plan for transportation. 4. Increased proportion of women breast feeding in the immediate and early postpartum period. Decreased case fatality rates (the proportion of complicated cases that result in death). These would include interventions such as the implementation of skilled care by medical practitioners such as doctors, nurses and midwives. This would then require extensive and appropriate training so that the process of childbirth is aided and emergencies are effectively dealt with., this intervention would have significance before, during and after childbirth. These would also then have long term ramifications in terms of planning such as family planning and education in the same; skilled health worker attendance and emergency medical services. Interestingly this mode is cost effective in as much as these if implemented successfully would be able to avert 80 percent of maternal deaths. A package of maternal health services costing less than U.S. $1.50 per person could make significant improvements in women’s health in the 75 countries where 95 percent of maternal and child deaths occur. The second set of requisite interventions would include increasing the availability of skilled health workers in the sector. This would entail steps to increase the numbers involved in the sector by more than 10 per cent. The labor involved would have to be skilled health workers which would then correspond to a 5 per cent reduction in maternal deaths. In parts of Asia, the proportion of women who have a skilled health worker present during delivery increased from 31 to 41 percent between 1995 and 2005. Increases have also been seen in many African countries. The third point to note here that of the fact that there are many countries of the third world that have successfully reduced maternal mortality. Examples are the success stories of countries such as Bangladesh, Nepal, Thailand, Malaysia, Sri Lanka, Egypt, Honduras and some of the southern States of India (Shiffman, Dtanton, and Salazar, 2004). The reason for this reduction is rooted in a number 0of factors that include escalating contact with hospitals and medical growing ubiquity of medical treatments. There have also been substantial improvements in standards of midwifery care, along with improvements in quality of care and controlling infectious diseases Millennium Deceleration set out eight specific Millennium Development Galois (MDGS) each with its own numerical target and indicators for monitoring progress. These goals give special priority to the health and well being of women mothers and children. The target set for MDG-5 is a 75 per cent reduction in the global maternal mortality ratio between 1990 and 2015 (Kunst and Houweling, 2001). The evidence is suggestive of the fact that a reduction 75 per cent is achievable within a twenty-five year’s time frame, similarly to the way in which some industrialized countries have managed to halve their maternal mortality rate in the latter part of the 19th century (Ehiri, 2009). The idea essentially would be the application of skilled health-care professionals at birth. Evidence from several transitional countries is also suggestive of the fact that this target is achievable. During the last 40 years countries such as Thailand, Malaysia, and Sri Lanka have managed to substantially reduce their maternal mortality rates which are now comparable with that of many industrialized nations (Campbell, Gipson and Isa, 2005). it is admittedly difficult for one to find trends for countries with high levels of maternal mortality, it has mostly been found that there has been little to no progress in the area, especially in the case of sub Saharan countries. It has been found that hypothetically it is possible to ensure tat the MDG for maternal health b reached in every country and the reduction of maternal and perinatal mortality globally would be well on the way. The problem here is that the achievement of these goals cannot be reflective of equity or universal coverage of care. It has to be therefore accepted that almost in all countries the rich population would be able to achieve the MDG but not the poor population reflecting the nature of divide between the rich and the poor that characterizes most of the third world. Reduction in maternal and neonatal mortality does not require new technologies or knowledge of effective interventions. The point to be made here is that the process and the aims at reduction of maternal mortality just needs the application of the resources and the facilities that are already available (Yamin and Maine , 1999). The challenge in the context of this case scenario is to find a method that would facilitate deliverance of services and scale up interventions particularly to those that are vulnerable and hard to reach, marginalized or excluded. It has to be understood that effective health care interventions already exist for mothers and babies and several proven means of distribution are available. None of them have any chance of being effective however in the absence of political will at levels where it matters most: the national and district levels. It also needs to be accepted in countries that face the burden of stagnation and reversal (particularly the nations of the sub-Saharan desert) barriers to the uptake of health benefits are a critical source of exclusion for many pregnant women (Van Lerberghe and De Brouwere, 2001). The present literature on the links between the problem of maternal mortality and poverty is very basic and has yet to look into the deeper abysses that define this relationship. The linking of health outcomes and service utilization rates with indicators of poverty is based only on asset ownership as reported by survey respondents, and this field of measurement is currently developing with the launching of new measurement initiatives (Diamond et al, 2001). It also needs to be understood that the existing analysis in the context of use of service cannot be defined as being refined enough that it could be of assistance with respect to the growth of the debates defining the role of public vis-à-vis private players in the healthcare sector especially in the third world. It must also be accepted that a lot of the proof that one finds on the topic of maternal health care uses citations of innumerable examples of the problems with the availability of trained personnel. This has its roots not just in the unwillingness of medical practitioners to practice in rural settings but also in the, but also to the disinclination of medical organizations and communities to allow mid level service providers to perform routine obstetrics (Matthews, 2001). These factors exacerbate the problem of poverty-constrained access to care. The problem is one of the mindset and an appreciation of the gravity of the issue. It is not a co-incidence that many of the countries of Asia and Africa that are characterized by low healthcare spends are also the ones that are defined by high maternal mortality rates (Mahaini1 and Mahmoud, 2005). The present expenditure especially in some of the low-income countries is not sufficient for the management and of support strategies and implementation of publics interest works that are required for significant improvement in maternal mortality rates. It is indeed ironical that most of these countries are unable to even utilize the finds allocated by international agencies such as the WHO. At the regional levels corruption and incorrect appropriation of funds is a problem given the fact much of the region has been had adverse impacts in terms of the extension of effective interventions. Further, the trend at present is to prioritize and focus funding on vertical, disease-specific programs. This has therefore meant that maternal health figures nowhere on list of importance and therefore is never much of a talking point. What this does is that it aggravates the problem of implementation of an integrated holistic program that focuses on all round development of health in the country as opposed to focusing on single illnesses (Lawn. Et. Al., 2005). This also then means that focus shifts from the need to build capacity in human resources, both of which are essential to support and sustain progress towards achieving the Millennium Development Goals. One has to mention at this juncture the role that is played by the system of public communication and information. This is available in the form of the regularly assembled data and surveys of populations. In this context the role of the political entities and the nature of their priorities along with consumer pressure play a vital role in the battle against maternal deaths. One has to understand that these have no direct links with the issue of poverty, but one cannot but accept that a richer population would demand if not ensure the procurement of a standard quality of care-a trend clearly visible in the work by commentators (e.g. Van Lerberghe and De Brouwere, 2001), who see this as being an innate element to progress towards our internationally cherished goals and targets for maternal health. Furthermore, the satisfaction of unmet need via good quality family planning services and the availability of safe abortion services are also very important foundations for the reduction of maternal mortality, and to the extent that these are linked with poverty, they form an indirect link between economic hardship and maternal ill-health. It is therefore believed that that there is a need for monitoring and investigating the material deaths would need to be modified in accordance with the numbers of deaths that occur and the capacity of the system to investigate factors that make contributions to deaths. It is undisputable that in the presence of a weak healthcare system, and an ever increasing number of maternal death cases, it is a given that investigations would look into examples followed by high profile action which would ultimately be aimed at the correction of systemic weaknesses and mobilization of commitment for action and resources (Fathalla, 2001). There is thus a need for countries to carry pout a process of self assessment in terms of their current status and select policy options that are feasible and most likely to demonstrate immediate effect. The point here is that the problems facing prospective mothers are varied over the geographical landscape in as much as some have to face absence of insurance, while in others the informal charges of healthcare are unaffordable. Action should therefore be tailored to suit challenges-appropriately selected packages of interventions are critical for success (Liljestrand and Pathmanathan, 2004). Perhaps the least developed area of human rights work in health relates to the large scale social and economic forces _ e.g. structural adjustment programs, health sector reform strategies, often negotiated with or imposed by international actors _ that in some countries are devastating whole health systems and having profound effects on the health of the population as well (Freedman , 2001). In conclusion therefore it may be reiterated that investing women’s inclusive reproductive health not only helps in the advancement of human rights and improves health and well-being of the individual but also benefits the society and national economies (Roudi-Fahimi, 2003). The idea inherent in the discussion on interventions and requirements where global maternal mortality is concerned has been rooted in the fact that much of the techniques available at present is sufficient towards the improvement of maternal health. the point is that there has to be a correct implementation of available resources which can only come about through political will;. Although difficult the task is not impossible as is exhibited from the Sri Lankan and the Malaysian success stories. Reference: WHO Report (2004). Beyond the Numbers: Reviewing maternal deaths and complications to make pregnancy safer. Geneva 2004. Retrieved May 19, 2010, http://www.who.int/reproductive-health/publications/btn/text.pdf World Health Report (2005). Make every mother and child count: The Lancet 365(9463): 977-88. Costs of scaling up priority interventions in low income countries: methodology and estimates. WHO Commission on Macroeconomics and Health, Geneva 2001. Ehiri, J., (2009). Maternal and Child Health: Global Challenges, Programs, and Policies. Springer Books. p411 Lerberghe, V. W. and De Brouwere, V. (2001) ‘Reducing maternal mortality in a context ofpoverty in (Van Lerberghe, W. and De Brouwere, V. eds) Safe Motherhood Strategies: A Review of the Evidence, Studies in Health Services Organisation and Policy. Vol.17. pp 1-5 Kunst and Houweling (2001), A global picture of poor-rich differences in the utilisation of delivery care, in (Van Lerberghe, W. and De Brouwere, V. eds) Safe MotherhoodStrategies: A Review of the Evidence, Studies in Health Services Organisation andPolicy, 17, pp 297-316. 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(1999). ‘Maternal mortality as a human rights issue: measuring compliance with international treaty obligations’. Human Rights Q . 21. pp563_607 Freedman, L. P., (2001). ‘Using human rights in maternal mortality programs: from analysis to strategy’. Center for Population and Family Health, Mail School of Public Health, Columbia Uni_ersity, 60 Ha_en A_enue New York, NY 10032, USA Matthews, Z., (2002). Maternal Mortality and Poverty. DFID Resource Centre for Sexual and Reproductive Health Read More