India tops the list of 10 countries which bear 60% of global maternal deaths, stillbirths & newborn deaths burden
Despite over 4.5 million women and babies dying every year during pregnancy, childbirth or the first weeks after birth, global progress on mitigating this has halted since 2015, revealed a new report by the United Nations (UN).
Stagnating investments and little political intent, augmented by the COVID-19 pandemic, rising poverty and worsening humanitarian crises, have compounded an already precarious situation, the document released on May 9, 2023, noted.
The report on improving maternal and newborn health and survival and reducing stillbirth placed India at the top, accounting for 17 per cent of global maternal deaths, stillbirths and neonatal births (788,000 total deaths).
Pregnant women and newborns continue to die at unacceptably high rates worldwide, and the COVID-19 pandemic has created further setbacks to providing them with the healthcare they need, said Dr Anshu Banerjee, director of Maternal, Newborn, Child and Adolescent Health and Ageing at the World Health Organization (WHO).
“If we wish to see different results, we must do things differently. More and smarter investments in primary healthcare are needed now so that every woman and baby — no matter where they live — has the best chance of health and survival,” she added.
Key findings of the report revealed how gains made between 2000 and 2010 were faster than they have been in the years since 2010.
Maternal mortality ratio observed an annual reduction rate of 2.8 per cent between 2000 and 2009, which decreased to 1.3 per cent between 2010 and 2020. An improvement of reducing this indicator by 11.9 per cent is required in the next decade to meet global targets of an MMR equivalent to 70 deaths per 1,000 live births.
Between 2000 and 2009, the stillbirth rate was reduced by 2.3 per cent and by 1.8 per cent between 2010 and 2021. A 5.2 per cent reduction is required between 2022 and 2030 to meet global targets of less than 12 stillbirths per 1,000 live births.
Neonatal mortality rate (NMR) records a similar trend; a 3.2 per cent reduction between 2000 and 2009, 2.2 per cent reduction in 2010 and 2021. NMR needs to be reduced by another 7.2 per cent between 2022 and 2030 to meet the global target of ending newborn mortality.
While progress has not been up to mark, meeting these targets by the end of this decade can still save close to eight million lives — over one million women, 2.6 million stillbirths and 4.2 million newborns. Doing so “will only be possible with high coverage of life-saving interventions combined with quality and equity across the continuum of care, from preconception to the postnatal period,” the report noted.
Following India, countries with the highest number of absolute maternal and neonatal deaths and stillbirths in 2020 are Nigeria (540,000 deaths), Pakistan (474,000), Democratic Republic of Congo (241,000), Ethiopia (196,000), Bangladesh (121,000), China (108,000), Indonesia (103,000), Afghanistan (95,000) and Tanzania (94,000).
These maternal and infant health indicators can be improved significantly by ramping up essential health services. Three standard measures can be used to assess this availability; at least four antenatal care contacts (ANC4), having a skilled attendant at birth (SAB) and receiving postnatal care (PNC) within the first two days after birth.
While coverage rates for ANC4 have improved to 68 per cent in 2022 from 61 per cent in 2010, the figure is projected to move up by only one percentage point by 2025. The same goes for SAB coverage rates, up from 75 per cent to 86 per cent in the same duration, and an expected improvement to 88 per cent by 2025.
For PNC, the coverage has recorded the highest improvement — up from 54 per cent to 66 per cent between 2010 and 2022. It is further projected to touch 69 per cent by 2025. The projections make it clear that ANC4 and PNC coverage will fail to meet global targets at the current pace.
“Upward trends are promising, but rates of improvement to increase coverage must accelerate if 2025 targets are to be achieved. Further, even when pregnant women, new mothers and newborns have access to services, ensuring they benefit from respectful and quality care remains a critical gap,” the report noted.
Bridging the emergency care lacuna for newborns and pregnant women is another hurdle without which achieving the targeted reduction in MMR, NMR and stillbirths will not be possible.
Only 51 per cent of countries are expected to have care units for small and sick newborns planned in 80 per cent or more districts by 2025. A closer region-wise analysis reveals only 35 per cent of countries in sub-Saharan Africa are expected to achieve this goal. In contrast, 71 per cent of countries in Central and South Asia have planned for coverage in 80 per cent or more districts.
Access to quality emergency obstetric care (EmOC) is critical for reducing maternal mortality. But only about 36 per cent of facilities providing EmOC in sub-Saharan Africa are considered functioning versus 62 per cent in northern Africa and western Asia and more than 80 per cent of EmOC facilities in other regions. Improvement on this front can significantly help reduce maternal deaths, a leading cause of which is postpartum haemorrhage — defined as the loss of more than 500 ml of blood within 24 hours after birth.
A set of interventions to manage postpartum haemorrhage can reduce heavy bleeding by 60 per cent, a new study has revealed.
The research, published in the New England Journal of Medicine, found “objectively measuring blood loss using a simple, low-cost collection device called a ‘drape’ and bundling together WHO-recommended treatments — rather than offering them sequentially — resulted in dramatic improvements in outcomes for women”.
A gender transformative approach can address maternal and newborn mortality. It is vital to stamp out the underlying factors which give rise to poor maternal health outcomes like socio-economic inequalities, discrimination, poverty and injustice, noted Dr Julitta Onabanjo, director of the technical division at the United Nations Population Fund.
Onabanjo argued in favour of including quality sexual and reproductive health services in universal health coverage and primary health care, particularly in vulnerable areas where mortality rates have either plateaued or even risen.
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