Maternal and Child Health Services
Dying to Give Birth
Major Causes of Maternal Mortality
- Unsafe abortion
- Bacterial infection and sepsis
- Pre-eclampsia (toxemia)
- Ectopic pregnancy
Over the past 15 years, maternal mortality rates have stubbornly flat in most countries. Each year, 210 million women suffer life-threatening complications of pregnancy. Over 500,000 women die each year from pregnancy-related causes; 99% in developing countries. Approximately one third of these deaths are due to postpartum hemorrhage in the developing countries of Africa and Asia. About 13% of global maternal mortality is due to unsafe abortion. In addition, 3 million babies die in the first week of life, and about 3.3 million infants are stillborn each year.
The majority of infant and maternal mortality is preventable with basic obstetric care and nutrition. This fact is supported by the sobering comparison of maternal mortality in developed and developing countries: 9 deaths/100,000 live births versus 450 deaths/100,000 live births.
To reduce mortality rates, women in developing countries should deliver in settings where emergency obstetric care (EmOC) is available if needed. Both WHO guidance and international consensus call for this. However, this is difficult to accomplish in resource-poor settings where the majority of women deliver at home, without a skilled attendant present, and far from hospitals.
Private Sector and Maternal Care
The private sector plays an important role in deliveries; both in home based deliveries, and in formal care. In a number of countries, including Egypt, India, Indonesia, and Nigeria, more births occur in private facilities than public.
Private village midwives (lay providers) have been trained in many countries as an expansion of attended normal deliveries and to make appropriate referrals for EmOC. Private professional nurse midwives play an important role in extending EmOC services in a number of countries, particularly in South Asia. Social marketing of prenatal vitamins occurs in a handful of developing countries, reducing the risk of anemia, placental complications, and pre-eclampsia.
Innovations in Gujarat have shown the potential of state contracting to private Ob/Gyn’s for quality management of all poor patients. This has been dramatically effective, reducing maternal mortality to developed country levels and creating improvements in survival rates in one year that decades of state program support had been unable to do.
In Vietnam and other countries where state facilities do exist, private sector sites are sometimes considered inferior, not because of their comfort or quality, but because of lack of integration to the national health system if needed for emergency procedures.
Deliveries are profitable, predictable, and patients are ready to pay for quality. Given all of this, we expect current trends towards increased use of private facilities for deliveries to continue in many developing countries.
- Private sector already a major source of delivery
- Effective use of informal village midwives
- Increased obstetric service provision options
- Successful provision of prenatal vitamins
- Provider willingness to refer at-risk patients
- Profit-center service clarifies transactions
- EmOC training can be complex and costly
- Poor Pre-eclampsia care
- Lack of skilled attendants
- Lack of obstetricians
- Lack of blood products
- Inadequate storage for blood products