October 16, 2015

The world is full of dangerous things—childbirth should not be one of them

Written by Tracy Romoser, communications officer, PATH

There is a well-known phrase in South Sudan that people say when they greet a new mother. Rather than “Congratulations,” they tell her, “Thank God you have survived.”

The reason is heartbreaking: Pregnancy is considered a dangerous life event. Across sub-Saharan Africa, most people know a woman who has died from complications during her pregnancy or delivery. And chances are that the woman and baby they’re greeting also faced death.

Childbirth has never been safer. So why is it still so dangerous?

Children enter the world in hospitals, in homes, sometimes unexpectedly, and always on their own schedule. An average of 353,000 babies are born each day. That’s approximately 255 births—per minute—around the globe (United Nations Children’s Fund).

However, childbirth doesn’t always progress in a predictable way. Women and children are still dying unnecessarily. Each year, something goes terribly wrong for nearly 300,000 mothers, the greatest number in rural and low-resource areas in sub-Saharan Africa and South Asia. And for 1 million newborns, their birthday is the only day of their lives.

Monica Oguttu was once a midwife in Kenya and saw this happen time and time again.

“I stopped practicing because it was so sad to have to go out and tell a husband holding a bouquet of flowers that his wife had just died and that his child at home was now an orphan.”

“These women are your friends, part of your community.” Oguttu, who is now the executive director of Kisumu Medical and Education Trust, says these losses are devastating and life-changing for many.

“You never forget when you lose a mother. It seems so senseless—the women are dying, but they shouldn’t be.”—Monica Oguttu

This is a stark reality that differentiates wealthy countries from the world’s poorest. These deaths result in more than heartbreak. They represent the loss of friends, workers, and family members. They represent the loss of futures.

It’s all about access and equity

“A healthy woman can come in with no signs she’s at risk. And then it happens in a flash.” Elizabeth Abu-Haydar, a public health specialist at PATH, is talking about the unpredictable nature of postpartum hemorrhaging, one of the many complications that can happen during a delivery or after a child is born. “The tragedy is that a woman can die within two hours of starting to bleed. A lot of these women are anemic, sick to start with, so they’re really at high risk of dying.”

“The tragedy is that a woman can die within two hours of starting to bleed. A lot of these women are anemic, sick to start with, so they’re really at high risk of dying.”—Elizabeth Abu-Haydar

Maternal mortality rates are higher in the global south where women have less access to skilled health care workers, medicines, and a suite of maternity services, including emergency obstetric and neonatal care.

To compound matters, fewer than half of the births in sub-Saharan Africa occur in health care centers or with skilled health care workers present.

The reasons are simple but quickly add up: A mother may have to arrange care for her other children before leaving home for a clinic. The clinic may be miles away and involve traveling on foot. In some cases, women are expected to provide their own maternity supplies and medicines, a financial hardship for many. And there may be cultural reasons why a woman remains home, or fear associated with delivering in a clinic.

By staying home, a mother puts herself and her baby at risk for complications during childbirth. If anything goes wrong, the difference between survival and death can be measured in minutes, and the nearest help may be hours away.

Delivering the right tools to the people who need them most

The success of a childbirth is strongly tied to having skilled health care workers involved during the delivery. When a doctor, nurse, or midwife is involved, there are fewer complications. A simple rural clinic works beautifully when it’s staffed and supplied.

And yet, in the world’s poorest countries, having these things in place is not always a guarantee that a mother and her child will receive the best care. One reason why: doctors, nurses, and midwives may not have all the medicines, tools, and training they need to address unexpected complications in childbirth.

The budget for interventions depends on where you live

On average, clinics in sub-Saharan countries are budgeted to receive US$30 to support each delivery. These budgets are set by the ministries of health based on what they’ve established as “most likely” needs. A life could be lost simply because the clinic receives one less dollar for an unanticipated need.

Parallel this financial constraint in developing countries to hospital and clinic budgets in wealthier countries and you begin to see the inequities.

In 2014, Melinda Gates addressed the World Health Assembly explaining that the majority of these newborn deaths are preventable with low-cost and sometimes entirely free interventions. Gates explained what she meant by preventable. “I don’t mean theoretically preventable under ideal but unrealistic circumstances. I mean preventable with relatively simple, relatively inexpensive interventions. Preventable with systems and technology available now in almost every country.”

Along with breastfeeding, one of the interventions Gates spoke about was “kangaroo mother care,” a method that encourages immediate skin-to-skin contact between a mother and her newborn child. Studies show that when infants are held in this manner, their respiration, heart rate, blood pressure, and other vitals strengthen and stabilize. Mothers also benefit from kangaroo care through the release of oxytocin, a naturally occurring hormone known as the “cuddle chemical.”

We can do better for low-resource settings

Although millions of people have benefited from innovations that improve the chance for a healthy life, access remains unequal around the world. In order for more mothers to experience the joy of childbirth, we need to accelerate interventions and proven solutions, and build successful public health systems that support doctors, health care workers, midwives, and families.

Lifesaving help arrives in a variety of forms, whether it’s a kit of medical supplies, a device used at the hospital level, or a new medicine that can be administered by a community health care worker. As the leader in global health innovation, PATH works on developing and delivering solutions like these.

In the end our goal is to save lives, but our hope is to have more happy mothers and babies.

Editor’s note: This post was originally published as part of the PATH blog series “Reclaiming the Future” on PATH.org.