Twenty years after the international community committed itself to making motherhood safer, the relentless toll of mothers dying continues: Every minute, another woman is taken from her loved ones. Every minute, a family loses its centre. A child loses a mother’s love and protection. Parents, friends and siblings mourn the loss. The preventable death of a mother is a tragedy that diminishes us all.

Strategies to prevent maternal mortality are well known. They start with providing quality maternal health care services, including family planning, skilled birth attendance and emergency obstetric care. But they don’t end there: Maternal health is linked to many other issues, including gender dynamics, poverty, human resources, health sector reform and political will. Here are some of the ways UNFPA is working closely with partners to address this multifaceted issue, with stories about individuals whose realities bring the problems and solutions to life.

Speeding Up Access to Skilled Attendance and Emergency Obstetric Care

Rapid access to life-saving emergency obstetric care is the key to saving lives when complications arise. Finding ways to overcome delays in getting care is critical. This can mean upgrading district level clinics, providing waiting homes for women in remote rural areas, or setting up clinics in tents or pre-fabricated buildings following emergencies. It also means putting in place evidence-based procedures and protocols that can help health care providers deliver the highest quality of care.

Getting Family Planning Supplies to All Who Need Them

Women in developing countries are literally dying for lack of family planning options. Eliminating unintended pregnancies would reduce maternal mortality by 20 per cent or more. Yet more than 200 million women would like to control their fertility but lack the means to do so. In Georgia, mobile health teams fan out across the countryside to provide family planning services and other reproductive health services to each of the country districts. In Senegal, volunteer health workers use bicycles to distribute contraceptives to rural villagers. Young people are often denied access to contraceptives, leading to high-risk teen pregnancies.

Ensuring Skilled Attendance

Skilled attendance at all births is considered to be the single most critical intervention for ensuring safe motherhood, because it hastens the timely delivery of emergency obstetric and newborn care when life-threatening complications arise. Yet midwives are in short supply in many developing countries – WHO estimates some 700,000 are urgently needed. Midwives typically endure low status, poor working conditions and a lack of support. In Darfur, in the Occupied Palestinian Territories, and elsewhere, UNFPA is working to strengthen quality midwifery care within the community as a way to reach out to women at risk.

Involving Men in the Issue

Men need to understand the vital role they play in protecting the reproductive health of their wives and daughters. They often have the final say in decisions about family planning, their wives’ activities and the use of household resources, decisions that influence the well-being and prospects of the whole family. The care and support of an informed husband can mean the difference between life and death. In Nigeria, men are learning about the dangers their wives face and how they can support them.

Preventing Child Marriage

Child marriage jeopardizes the health and limits the opportunities afforded to women. It usually disrupts their education and often violates their human rights. Some 14 million women and girls between ages 15 and 19 — both married and unmarried — give birth each year. For this age group, complications of pregnancy and childbirth are a leading cause of death, with unsafe abortion being a major factor. In Ethiopia, girls are being rewarded for staying in school. In Kenya, those who resist coerced marriages are granted a safe haven.

Responding to the Health Needs of Pregnant Women in Emergency Situations

In a crisis or refugee situation, one in five women of childbearing age is likely to be pregnant. UNFPA seeks to make motherhood as safe as possible during crisis situations by helping those who want to delay or avoid pregnancy and by providing care before, during and after delivery. Whether the emergency is due to violence, as in Timor-Leste or Chad, earthquakes, as in Indonesia and Pakistan , or a hurricane, as in Guatemala, UNFPA stands ready to assist pregnant women in this time of compounded vulnerability. 

Giving Special Attention to Populations Most at Risk

Maternal mortality is the most skewed of all health indicators. Impoverished rural women often face risks orders of magnitude higher than their better-off or urban counterparts. Addressing populations that are marginalized by poverty, conflict or location is part of a human rights-based approach to the ultimate violation of human rights – the preventable death of an innocent person. Indigenous women in Latin America face risks far higher than in the general population, as do the women of rural Viet Nam and war-torn Afghanistan.

Ending Fistula

Women who suffer obstetric fistula are those who very nearly died trying to give life. Preventing fistula requires the same strategies as making motherhood safer more generally. The UNFPA-led Campaign to End Fistula is implementing these strategies in some 40 countries where maternal mortality is high. It is also providing treatment and rehabilitation for women like Kouboura and Shahin, who have endured agonizing deliveries and debilitating injury.

Addressing the Complications Caused by HIV

Safe delivery can be compromised by the presence of HIV. As the number of HIV-positive women increases, so does the need for reproductive health services tailored to their needs – for family planning, safe delivery and for breastfeeding counselling. All women should be routinely offered voluntary testing and counselling when they come in for services such as pap smears and antenatal care. This kind of routine care would have made a real difference for Juliet Ajav-Nyior of Nigeria.

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