The lowest coverage levels tend to be in the poorest countries where maternal mortality levels are highest, it says
More than 800 women still die from pregnancy-related complications every day despite several technological advances and increase in institutional delivery rates, a Unicef report has revealed.
Attributing this primarily to what it called the “catastrophic cost of childbirth”, Unicef said more than more than five million families across Africa, Asia, Latin America and the Caribbean spent over 40 per cent of their non-food household expenses on maternal health services every year.
Nearly two-thirds of these affected households, or around three million were in Asia, while approximately 1.9 million were in Africa, the analysis says. The report is a recently-released stocktaking exercise of maternal health by the United Nations body.
“For far too many families, the sheer costs of childbirth can be catastrophic. If a family cannot afford these costs, the consequences can even be fatal,” said Unicef executive director Henrietta Fore. “When families cut corners to reduce maternal health care costs, both mothers and their babies suffer.”
This assumes significance because, according to the World Health Organization (WHO), 216 mothers still die per 100,000 live births while the Sustainable Development Goals aim to reduce this to 30 by 2030.
As far as institutional delivery (facilities like hospitals, trained health care professionals for expectant mothers) is concerned, the Unicef analysis says that though it has improved considerably in the last decade, variations between different countries were glaring, thus impacting the overall scenario.
“The lowest coverage levels tend to be in the poorest countries where maternal mortality levels are highest,” the report says. A look at the dataset of the report reveals that in South Sudan and Somalia, less than 20 per cent of expectant mothers had institutional delivery while in Niger, Chad and Ethiopia 20-40 per cent mothers had the facility.
C-section is an important tool to avoid maternal deaths in case of a complicated pregnancy. However, many countries, especially those in West and Central Africa don’t have adequate access to this “lifesaving intervention”, with only four per cent deliveries happening through C-section there.
The report also points out to what it calls the “over-medicalistion of childbirth” in Latin America and Caribbean countries, with 44 per cent deliveries happening through the surgical method.
The high number of adolescent mothers becoming pregnant also is a matter of concern. In fact the analysis reckons that globally, the complications caused due to pregnancy outnumber all other causes of mortality in girls aged between 15-19 years.
“In addition, their children are at a higher risk of dying before their fifth birthday. Yet, the report finds that child brides are less likely to receive proper medical care while pregnant or to deliver in a health facility, compared to women married as adults,” says a press release issued by Unicef.
Sub-Saharan Africa registers the maximum number of childbirths in adolescent mothers. Seventeen sub-Saharan African countries have adolescent birth rates (annual number of live births per 1,000 adolescent women) or exceeding 120 births per 1,000 girls aged 15 to 19.
Mali, Niger, Chad and Angola have adolescent birth rates of 150-230, which is the highest in the world. In India, the rate is 50-99.
Typically, child brides end up having many children to care for, often more than women who marry as adults, thwarting their own life chances while increasing the overall financial burden on their families.
In Cameroon, Chad and the Gambia, over 60 per cent of girls aged 20-24 who married before turning 15, had three or more children, compared to less than 10 per cent of women at the same age who married as adults, says the release.
Uneven distribution of human resources in health is another cause of a high maternal mortality rate. While the number of human resources did go up, the coverage left much to be wanted in the poorest countries where both maternal and neonatal mortality rates are the highest, ironically.
The report says, “For example, from 2010 to 2017, coverage increased from four to five health workers per 10,000 people in Mozambique, and from three to nine in Ethiopia. In Norway, that number increased from 213 to 228 health personnel per 10,000 people over the same period.”
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