Maternal death: a preventable tragedy.

Maternal death: a preventable tragedy

At 11, Rashida is a married woman. Like many other girls from the Indian sub-continent, she will probably have her first child before she turns 15. Her grandmother, at 42, is pregnant with her ninth child. For both Rashida and her grandmother, giving birth will not be a happy event, but a source of worry--with reason. Neither of them might survive.

Every year about half a million women throughout the world die as a result of pregnancy. "It is intolerable that so many thousands of women are dying painful, lonely deaths in the process of giving life and we are doing so little to stop it", said Pakistan Population Minister Dr. Attiya Inayatullah at the 1987 Conference on Safe Motherhood held by UNICEF at Nairobi, Kenya.

Maternal deaths--deaths of women during pregnancy, or within six weeks of its termination from pregnancy-related causes--are caused largely by lack of proper care before, during and after delivery. But it has also been linked to traditional practices which may considerably increase dangers for pregnant women.

Too young, too old,

too many, too close

Women who have multiple, closely-spaced births are most at risk. Post-partum haemorrhage, the leading cause of maternal death, is most common among women who have not let their bodies recover from successive pregnancies. In a typical case, a woman, usually over 30, literally bleeds to death after one childbirth too many.

Teenage motherhood can be equally dangerous. Obstructed labour may occur when a baby is blocked in a pelvis which has not reached its full size, leaving an exhausted young woman to die from bleeding, sometimes after days of labour.

If Rashida gives birth at 15, her chances of dying from pregnancy-related causes would be five times greater than if she waited until she is 20. But even if she survives an early pregnancy, she may suffer permanent damage. For each teenage mother who dies in childbirth, a dozen are left with torn vaginas or urethras.

Abortion is another major killer. Perhaps half of the 60 million-odd abortions performed every year are illegal, resulting in the deaths of 200,000 women. In some Latin American cities, back-alley abortions account for up to half of all maternal deaths.

Poor countries

disproportionately affected

Women in developing countries are particularly affected. Lack of pre-natal care and trained personnel, especially in remote villages, is compounded by adherence to traditional customs encouraging early marriage and multiple births. In many countries, women are undernourished and overworked during pregnancy.

As a result, the overall risk of dying from pregnancy-related causes is 40 times higher in poor countries than in rich ones. No other social indicator--be it literacy, life expectancy or infant mortality--shows a wider gap between the developing world and the industrialized world.

In some African countries, such as Nigeria and Benin, maternal mortality rates are as high as 1,500 deaths per 100,000 live births, 150 times the developed world average of 10.

Combined with high fertility, such rates increase the risk faced by individual women in developing countries. In Africa, where the overall maternal mortality rate is 700 per 100,000 births and each woman gives birth to more than six live babies, the lifetime odds for women to die from pregnancy-related causes are 1 in 20. North American women, by contrast, face a risk of 1 in more than 6,000.

Birth spacing is the key

Most of these deaths, according to UNICEF, can be avoided at low cost. The 1987 Conference on Safe Motherhood at Nairobi concluded that it should be possible to reduce maternity death rates by at least half by the end of the century, if family planning--notably birth spacing--can be successfully promoted throughout the developing world.

"Birth spacing is one of the most powerful ways of improving the health of children and their mothers," UNICEF Executive Director James Grant said at the Conference. "When family planning is effectively included with other low-cost measures to improve the health of children and mothers, a survival revolution can be expected in most developing countries."

A single pre-natal examination could identify three-quarters of women at risk, a report by the UN Population Fund (UNFPA) shows. UNICEF reckons that spacing births by at least two years and stopping pregnancies after the age of 30, besides stemming population growth, would prevent a quarter of both maternal and infant deaths.

Health of mothers and

children interdependent

Maternal mortality and child mortality go hand in hand. The more often children die, the less time mothers wait to get pregnant again; the less mothers wait, the more children die. According to UNICEF, the risk of death for young children increases by about 50 percent if the space between births is less than two years.

The link between the health of the mothers and that of children, and the fact that maternal deaths leave one million children motherless each year, is increasingly becoming the focus of international action.

In late 1988 UNESCO, UNICEF, and WHO co-operated in issuing "Facts for Life", a booklet for educators and families explaining, in clear and simple terms, birth-timing, feeding, and other issues affecting the health of both women and children.

UNICEF's "Operation Safe Motherhood" emphasizes regular check-ups, and food and rest for pregnant women. It also stresses the need for qualified persons to be present at birth--the percentage of births attended by trained personnel is just under half in Asia and barely one third in Africa.

Governments must take

the lead

But these and similar initiatives by the non-governmental organizations have little chance of success without government participation. Building facilities, training birth attendants, providing referral services so that more qualified people can deal with more complex problems require active official involvement.

"Government commitment and engagement are essential in order to stop the unnecessary loss of lives," concluded the Inter-African Committee on Traditional Practices Affecting the Health of Women and Children after its meeting in Niamey in February 1989.

The role of Governments is all the more crucial that improvement will depend on a cultural revolution: the shedding of traditional values connected with low status of women in those societies.

At the Niamey conference, African Governments have courageously begun to address these issues. In their final statement the delegates called on policy-makers to "take appropriate measures to eradicate such harmful traditional practices" as nutritional taboos, female circumcision and childhood marriage.