[This post has been written by Clara Menéndez, Anna Lucas and Azucena Bardají, from ISGlobal's Initiative of Maternal, Infant and Reproductive Health and has been published today, International Women's Day, on El Pais' online magazine Planeta Futuro]
Millennium Development Goal (MDG) 5 on improving maternal health will not meet the targets established in 2000. In 2015, maternal deaths will have been reduced globally by 50% (compared to the 75% target) and about 40% of women of reproductive age will still lack access to contraception—a far cry from universal access? How have we failed?
The issue of maternal health has become more visible in recent years, but despite many new initiatives and programmes and the fact that funds for health cooperation have tripled, the resources allocated to expanding family planning and quality obstetric care have barely increased at all. An estimated 287,000 women and girls die in pregnancy and childbirth every year. Almost all of these deaths occur in sub-Saharan Africa and South Asia. These are not deaths due to illness. These are deaths caused by the normal complications that arise in a percentage of all pregnancies (around 15%) in any setting. In high-income countries we have solved these problems by providing quality maternity care for all women. This is not the case in low- and middle-income countries. In those areas, despite improvement in some aspects (access to contraception and prenatal care), the more complex complications, the ones that require a more efficient and effective health system, are still not covered by highly inequitable health care systems. Over 40% of all births in the world are not attended by a trained professional. Nor do these mothers receive care after the birth, which is the most critical period for both mothers and their babies. Furthermore, while 80% of women from higher socio-economic groups have access to a delivery under the supervision of a qualified professional, among the more disadvantaged groups this percentage drops to between 10% and 30%.
What determines access to the obstetric care that can save lives? Mainly the cost of care, distance from health care facilities, and the quality of care, either real or perceived by the users or their families (around half of all women cannot decide independently to seek health care services).
The delay in recognizing the contribution of indirect causes (the exacerbation of pre-existing conditions) to a large number of maternal deaths has hampered the integration of malaria and HIV/AIDS programmes and those dealing with reproductive health. And although we now have better estimates of the total number of deaths that occur, the quality of data on cause of death is still a knowledge gap that prevents us from identifying and prioritising the most needed interventions, evaluating existing programmes, and establishing responsibilities.
Our feelings on taking stock are mixed: globally and in many countries the indicators have improved, but maternal and infant mortality has mainly been reduced only in more affluent social groups. Health care coverage has increased and levels of inequality have been reduced significantly only in countries where measures have been implemented to ensure access to maternal health services for women of all socioeconomic groups (maternal insurance systems, exemption from charges, free transport services for obstetric emergencies, and so on). And those are precisely the countries where we see a reduction in maternal mortality. These are the issues that need to be considered when the agenda for the coming years is being defined and the need for an approach focused on universal health coverage is being advocated. As long as universal health coverage is not a reality in the field of maternal health we will continue to see thousands of preventable deaths.