June 26, 2014

North-South Divide of Maternal Mortality: Bridging the Gap

Written by Emma Saloranta, Girls' Globe blogger

This post originally appeared on the Girls’ Globe website here. Reposted with permission.

gg-northsouthdivide-250x250In many developing countries, a woman’s chance of dying in childbirth can at times surpass her chance of surviving it. While the global maternal mortality rate has decreased 45% since 1990, around 800 women continue to die every day as a result of pregnancy and childbirth related complications. Most of these deaths are preventable, and many could be avoided through simple and often very low cost solutions and interventions. For millions of women, the lack of availability of basic medical services, such as trained nurses and midwives, and the lack of accessible clinics and cheap basic medicine such as antibiotics can lead to grave consequences, sometimes for both mother and the baby. The first day of a newborn’s life – a day that should be marked with sheer joy and happiness – has also been identified as the most dangerous day for both mother and the baby. For millions of mothers and babies, pregnancy and childbirth are shadowed by immense risk and danger, and what should be a start of a new life too often is the end of one.

In the meantime, in other countries like the United States, pregnant women and newborns are facing other types of problems – almost the opposite than women in developing countries. While women in developing countries lack access to the most basic maternal healthcare services, women in America face an increasingly medicalized birthing experience. Approximately 1 in 3 babies born in the US is delivered via c-section, compared to 1 in 5 in 1996.  While a c-section can be lifesaving to both the mother and the baby in certain situations, medical necessity does not explain the sudden and drastic increase in c-section rates – nor does it explain the dramatically different rates of c-sections between individual hospitals. Other medical interventions such as episiotomies are commonplace, and while the rate of midwife-assisted births is rising int the US, a vast majority of births – near 90% – are still handled by OBs, even though in most other developed countries normal births are routinely handled by trained midwives. On the other hand, as pregnancy and childbirth in the US and other western countries is becoming more and more medicalized, the cost of childbirth is also rising to the point of unaffordable. The US has been ranked as the country with the highest cost of childbirth in the world, with an average cost of vaginal birth hovering around $30,000 and c-section around $50,000 – pricing many couples out of safe, healthy pregnancy and childbirth experience. While maternal mortality rates are declining in every other western country, they are on the rise in the United States, which ranks behind every other industrialized nation in terms of maternal mortality. This is despite the fact that the US spends more than any other industrialized country on maternal health related costs.

The challenges faced by women in countries like India or Kenya differ drastically compared to the challenges faced by women in America – and the dangers related to pregnancy and childbirth might stem from different reasons – but the bottom line is that women in developing countries and women in America continue to die during pregnancy and childbirth at alarming rates, mostly from preventable causes. Accessibility of maternal care isn’t only a question of a health clinic or hospital existing nearby – it includes affordability, quality and nature of available health care as well. There are huge disparities in terms of quality of care in the United States, and health care is becoming a luxury good only available to those who can afford to pay hefty insurance fees. In developing countries, something as simple as lack of a trained midwife can become a question of life or death for pregnant women, who too often end up giving birth in dangerous settings with no trained health care workers available for support.

There is a divide between the North and the South in terms of maternal health and maternal mortality – but unfortunately, right now this divide is being bridged from the wrong direction, where the situation in certain western countries seems to be worsening while the situation in developing countries is not showing adequate signs of improvement. One thing is clear across the world – women and children cannot afford to wait any longer for proper, quality maternal and newborn health care services to become available to them. Business as usual is simply not enough, because every day that passes without change means hundreds of lives lost for preventable causes. A life of a mother and a life of a child must be valued the same everywhere in the world. It’s time to commit to action, and time to commit to deliver – there should be no agenda more important than that of saving the lives of mothers and their children.