Innovation for Maternal and Child Health in Sub-Saharan Africa: A Social Determinants Approach

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Maternal deaths have become largely preventable in the developed world due to significant advances in health care services and medical technology. So much so, the rate of maternal mortality has replaced financial indicators such as the gross domestic product (GDP) as a lead development indicator to highlight disparities between rich and poor countries [1]. About 99% of maternal deaths occur in developing countries (230 per 100,000 live births versus 16 per 100,000 in developed countries) and obstetric complications continue to be the leading cause of death for women in developing regions [2]. Approximately 800 women die everyday due to preventable causes related to pregnancy and childbirth [2].

Sadly, sub-Saharan Africa lags behind on measures of sexual and reproductive health in comparison to other developing countries. Although it is home to only 15% of women aged 15-49 in developing regions, half of the world’s maternal, child and newborn deaths occur in sub-Saharan Africa and children under the age of five are 15 times more likely to die compared to high-income countries [3]. The primary complications that account for maternal and newborn mortality include [2]:

  • Severe bleeding
  • Hypertension (pre-eclampsia and eclampsia)
  • Obstructed labour
  • Infectious diseases
  • Unsafe abortion

WHO data

[2] World Health Organization, May 2014. Maternal Mortality. Accessed: http://www.who.int/mediacentre/factsheets/fs348/en/

As one of the eight Millennium Development Goals (MDGs) adopted by international world leaders, countries were committed to reducing maternal mortality by three-quarters between 1990-2015. While progress for achieving MDG5 by the 2015 deadline falls short with only a 45% reduction between 1990-2013, all regions have made important gains with increased access and availability of maternal health services and skilled care [4].

Why is Change Difficult? Delays with the 3-Delay Framework

Most maternal deaths in developing countries can be prevented through adequate nutrition, proper health care, access to family planning, and the presence of a skilled birth attendant during delivery and emergency obstetric care. However, only about 51% of deliveries in low income countries were attended by a skilled health worker and less than half of women received at least four antenatal checkups (46%) or gave birth in a health facility (48%) – two strategies recommended by the World Health Organization to ensure the well-being of mothers and newborns [5].

Current maternal health policies focus on improving health services through antenatal care, safe delivery, and postnatal care. The idea is that the availability of family planning, professional delivery, and emergency obstetric care may be an effective solution for avoiding delays in seeking, reaching, and receiving appropriate care that often precedes maternal and neonatal deaths. In response to global health efforts, the proportion of deliveries attended by skilled health workers in developing regions increased from 56% to 68% between 1990-2012 , and more women are now receiving antenatal care (65-83% from 1990-2012) [4]. However despite these improvements, maternal mortality rates remain 14 times higher in developing regions in comparison to the developed world [4].

Effectiveness is only partly determined by the delivery of health services and qualifications of health care workers. To date, maternal health policies have rarely considered the root causes of maternal mortality: poor nutrition, low female educational attainment, early marriage and child bearing, harmful cultural and religious practices, domestic violence and unsafe abortions (which accounts for 13% of maternal deaths globally) [5, 6]. When gender biases and social inequalities exist in health contexts, it manifests in poor quality care and treatment by the community. Efforts to improve health services are ineffective when the professional delivery of care and institutional backup cannot be sustained.

Empowerment and Accountability of Communities for Change

A sustainable and long-term approach to maternal and child health in sub-Saharan Africa requires not only improvements to the immediate environs of pregnancy and labor, but a political will to empower community level groups and create a paradigm shift that has zero tolerance for unnecessary deaths, illness, and violence that inflicts girls, women, and children in developing regions. Prevention strategies must consider the intersection of poverty and gender biases that can help avoid these detrimental health inequalities [6].

To ensure changes are sustained within a community that is obscured with social inequalities, efforts to shift the attitudes and mindsets of the community and health care providers is essential to quality care. By working from the ground up, the implementation of policies and programs that support increased awareness, access, and accountability for women’s health rights among the community can contribute to effective and sustainable health services.

References:

  1. World Health Organization, 2015. Global Health Observatory: Maternal and Reproductive Health. Accessed: http://www.who.int/gho/maternal_health/en/
  2. World Health Organization, May 2014. Maternal Mortality. Accessed: http://www.who.int/mediacentre/factsheets/fs348/en/
  3. World Health Organization, September 2014. Children: Reducing Mortality. Accessed: http://www.who.int/mediacentre/factsheets/fs178/en/
  4. United Nations, 2015. Goal 5: Improve Maternal Health. Accessed: http://www.un.org/millenniumgoals/maternal.shtml
  5. Guttmacher Institute, 2014. Fact Sheet: Investing in Sexual and Reproductive Health in Sub-Saharan Africa. Accessed: http://www.guttmacher.org/pubs/FB-AddingItUp2014-SSA.html
  6. Sen, G., 2007. Health inequalities: Gendered puzzles and conundrums. The 10th Annual Sol Levine Lecture on Society and Health, October 6, 2008. Soc Sci Med, 69(2009) 1006–1009.

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