ACTIONS, PAST AND PRESENT

REDUCING MATERNAL MORTALITY

Situation It is not uncommon for women in Africa or in parts of Asia, when about to give birth, bid farewell to their older children. "I am going to the sea to fetch a new baby, but the journey is long and dangerous and I may not return".

At this time and age, women continue to die during pregnancy and childbirth. The 1995 estimates of maternal deaths for the world was 515,000. In terms of maternal mortality ratio, the global figure is estimated to be 400 per 100,000 live births. Of these deaths, 98 per cent occur in the developing world.

The direct causes of maternal deaths are the same all over the world. The majority of maternal deaths are the direct result of complications arising during pregnancy, birth, and postpartum: postpartum haemorrhage, sepsis, complications of unsafe abortion, prolonged or obstructed labour and hypertensive disorders of pregnancy especially eclampsia. Because these complications occur at any time during pregnancy or childbirth without forewarning, timely access to and use of quality obstetric services is essential.

The average risks of women dying in the developing world from complications of pregnancy and childbearing are much higher than the risks women in the developed world are exposed to. For instance, the lifetime risks of pregnant women dying in Africa is 1 in 16 while the lifetime risks of pregnant women in North America is 1 in 3,700. Thus, of all human development indicators, maternal mortality ratios show the greatest disparity between developed and developing countries.

This is not the entire picture, however. According to WHO estimates, some 15 million women develop short- and long-term disabilities as a result of pregnancy and childbirth. Such disabilities which include rectal and vesico-vaginal fistulae (an abnormal passageway from the rectum or urinary bladder to the vagina which has developed due to prolonged obstructed labour) and infertility compromise women's quality of life.

As a consequence of maternal deaths and disabilities, infants and children also suffer. Tragically, when a mother dies, her new-born child is most likely to die. The older children, most often girls, have to leave school to take care of household chores.

Maternal mortality can be prevented by helping women avoid unwanted pregnancies through family planning and by ensuring that skilled birth attendants, i.e., doctors, nurses, and midwives, provide appropriate ante-natal and post-natal care, essential obstetric care, and effective post-abortion care. It must be emphasised, however, that the overall effectiveness of skilled birth attendants is dependent on immediate access to emergency obstetric care (EOC).

Actions One of the goals, which the WSC Plan of Action and ICPD POA articulates, is to reduce maternal mortality ratio by half of 1990 levels. UNFPA supports a variety of measures to bring maternal mortality ratios down - from provision of family planning services, education of communities on safe motherhood to training professional health care workers in essential obstetrics and providing equipment and supplies to health facilities. Approximately two thirds of the world's women of reproductive age are now using a method of contraception.

To assist women during normal deliveries, UNFPA supports efforts to improve the skills of service providers. In addition to this, for women who experience pregnancy complications, UNPA assists in the establishment of emergency obstetric care which includes upgrading health care facilities, providing equipment and supplies as well as ensuring that transportation to health centres is available. UNFPA further seeks to improve the health and nutrition of women and adolescent girls.

In Bangladesh, 18 maternal and child welfare centres were renovated and upgraded in the year 2000 to provide comprehensive services, especially EOC, and 30 doctors completed a one-year training in obstetric care and anaesthesiology. Over the last three years, skilled attendance at birth in Bangladesh has risen from 8 to 13 per cent.

In places where there are no skilled birth attendants, UNFPA provided funds to build traditional birth attendant huts in Malawi and 'maternity houses' in Guatemala where women with high obstetric risk or women coming from faraway places can be monitored before their delivery date. In India, UNFPA supports a local level project which provides transport assistance to women who have to go to hospital for EOC.

In Nepal, where 6 per cent of births are assisted by skilled birth attendants and one in 10 pregnant women go through childbirth alone, UNFPA is working with local mothers' groups to improve maternity care. In the year 2000, over 24,000 mothers were trained by volunteers in reproductive health. These mothers, in turn, spoke to other women in their communities and distributed family planning supplies and information. They also organised themselves to create and manage revolving funds for emergency obstetric care for women who face life-threatening complications during birth.