One-third of total maternal deaths in 2015 happened in India

Since 1990, the gap between the countries with the highest and lowest level of maternal mortality has widened. In fact, it has doubled. According to the 2016 Lancet Maternal Health Series released recently, it is important to improve the quality of care and reduce disparities in access to health care services. The study analyses the causes, trends, and prospects for maternal health in the era of rapid demographic and socio-economic transition.

Widening inequities in maternal health

Despite falling birth and death rates, the unfulfilled need for contraception continues to drive population growth, putting stress on already fragile health infrastructure. The study observed that indirect causes of maternal mortality and morbidity are becoming more prominent with low- and middle-income countries also witnessing a rise in cases of diabetes, heart disease, hypertension and other chronic conditions.

Lifestyle and behavioural changes, leading to first-time pregnancy among women in late 30s and 40s, are further complicating the situation. Women are more vulnerable to climate change-related disasters and environmental degradation that compel them to spend more time on surviving sudden changes and less on taking care of themselves. The unabated spread of vector-borne diseases like malaria, Zika and Ebola are also putting maternal health at risk.

Global status on maternal health

• Nearly 25 per cent of babies worldwide are delivered in the absence of a skilled birth attendant.
• One-third of the total maternal deaths in 2015 happened in India, where at least 45,000 mothers died during pregnancy or childbirth
• Nigeria shared the maximum burden with about 58,000 maternal deaths.
• In sub-Saharan Africa, the risk for a woman dying during pregnancy or childbirth is 1 in 36 as compared with 1 in 4,900 in high-income countries.
• Although maternal mortality rates are decreasing in high-income countries, there is still wide variation at national and international level. For instance, the maternal mortality ratio in the US is 14 per 100,000 live births. In Sweden, the ratio is 4: 100,000.
• In 2015, 216 women died of maternal causes per 100,000 live births, which is a 44 per cent drop from 385 per 100 000 in 1990. However, the global target for 2030 is 70 per 100,000.
• Three-quarters of women now deliver with assistance from a skilled birth attendant and two-thirds receive at least four antenatal care visits.
• Nearly 53 million women, mostly belonging to the poorest countries, receive no skilled assistance at birth.
• While high-income countries have 51 high quality evidence-based guidelines available for maternity care services, low-income countries don’t have such guidelines.
• In the US, average cost for vaginal births was more than seven times higher than in Norway. For caesarean sections, average cost is more than four times higher.

Sub-Saharan Africa

In five of the seven sub-Saharan African countries studied during the research, more than 25 per cent of their facility births happened in sites that lack capability to provide care even for uncomplicated childbirth.

Sub-Saharan African countries with the largest numbers of births (Tanzania, Kenya and Ethiopia) have less than two midwives and obstetricians per 1,000 pregnancies.

In four countries, more than two-thirds of facility births were in sites that lacked basic infrastructure like water. Over 50 per cent of facility births were in sites that didn't have basic emergency obstetric care.

According to estimates, over 18 million additional health workers are needed by 2030 to meet the Sustainable Development Goals.

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