TrendFrom years 2000 to 2015 there wasa general trend of a reduction in maternal mortality. This was investigated bythe UN who included this cause in their 2000 initiative Millennium DevelopmentGoals. At present the level is at 216 deaths per 100,000 live births which isan average reduction of 2.3% per year since 2000 when the level stood at 385. Onuniversal comparison this trend highlighted the link between better healthcare (andbetter access to this healthcare) and the low mortality rates of developedcountries compared to developing – where 99% of maternal deaths occur today. Themain cause of death was haemorrhage and so without access to quality healthcarethe developing countries were unable to prevent these deaths and more (UNICEF2017) (WHO 2015.)ChallengesFirstly there is a problem withdata collection in terms of its quality and how it is measured.
In order totarget the maternal mortality rate it is required to know what these numbersare and in what scenarios these deaths they take place. Often the worstaffected countries are those will little data as they are usually in a state ofcrisis whether it be natural disaster, war or a health epidemic. Other datashortfalls leave subsets of populations overlooked in the face of an overalllow maternal mortality rate nationally. This was seen in the case of Australia withindigenous populations where maternal mortality rate was double that ofnon-indiginous, as found by a study purposely examining this subsection in society(WHO 2015).
HIV epidemics are a prominentproblem with countries deemed at having made no progress since 2000. The burdenthis takes on the nations resources has a knock-on effect into availability ofmaternal care. These countries also can have the added hindrance of nationalstrife and other crises simultaneously with the HIV epidemic. To tacklematernal deaths these issues must be acknowledged and addressed in combinationwith any approach these factors are what prevents progress (WHO 2015).Keeping abreast of the observedshift in cause of maternal deaths is also a challenge.
While maternal mortalityrates may have declined there can then be an increase in proportion of laterobstetric complications and causes of death that pregnancy has exacerbated. Theapproach to improvements will need to be adapted to shadow this shift to more theseindirect deaths and obstetric complications (WHO 2015).OpportunitiesTo address the data problemcountries can implement programmes such as the Confidential Enquiry intoMaternal Deaths (CEMD) for correct classification of maternal deaths in the country’snational statistics. As a prelude to this the Maternal Death Surveillance andResponse (MDSR) can be used to build the data network. This would be helpful inkeeping track of the current data and any emerging shifts. The efficiency ofthis could be augmented by going digital in the approach such as with the OpenSmart Register Platform.
Programmes such as these provides frontline healthcareworkers with means to record and monitor the health of those they treat. Accessto healthcare, increasing proportion of healthcare dedicated to women and healthinsurance schemes have also shown to have an impact and so should be morewidely utilized (WHO 2015) (Filippi et al 2016).Maternal mortality is closelylinked to poverty. Access to family planning has a strong link with long termeconomic advancements and in so a path out of poverty at a national level. Withfamily planning there are less children to care for, the births are spaced tobetter allow for the survival of the children that are born and women are ableto advance their education and enter the paid workforce.
The SustainableDevelopment Goals 2015 emphasises the global recognition of the importance ofthis issue as is also highlighted by the fourth International Conference onFamily Planning, that focuses on reducing population to eliminate poverty. Herethe conference observed a majority voicing the importance on long term reversiblecontraceptive devices as they key to success. By making this a prominentapproach it would facilitate long term change, the economy also and be lesssensitive to epidemics. (Canning and Schultz, 2012)