WUNRN
Doctors Without Borders
http://www.doctorswithoutborders.org/our-work/medical-issues/womens-health
WOMEN’S HEALTH – MATERNAL MORTALITY – CARE INEQUALITIES: GLOBAL REALITIES
Wendy
Marijnissen
Facts
99%
of maternal deaths occur in developing countries.
The
main causes of maternal mortality are hemorrhage, sepsis, eclampsia, unsafe
abortion, and obstructed labor.
One
woman dies every six minutes from unsafe abortion.
Wealthy
countries have reduced mother-to-child transmission of HIV to under 1%. The
transmission rate is 25 to 45% in poor countries.
Women's Health
Every
minute, one woman around the world dies from pregnancy or childbirth
complications.
The
pathologies that kill women during their pregnancies, deliveries, or just after
giving birth are the same throughout the world. What makes the difference is
access to quality health care. The vast majority of maternal deaths, 99
percent, occur in developing countries. More than half of these deaths occur in
sub-Saharan Africa, and one third in South Asia. In wealthier countries, the
availability of affordable and effective treatment prevents the conditions that
continue to kill pregnant women in developing settings.
In
more than 20 countries, MSF focuses on reducing maternal and infant mortality
through care during pregnancy and prenatal consultations, emergency obstetric
care, postnatal care, and access to contraception and family planning services.
Likewise,
obstetric fistulas—a condition that affects women who have experienced
prolonged obstructed labor—were eradicated in more developed countries at the
end of the 19th century, when Caesarean section became widely available.
However in poor and conflict-affected areas, women are unable to access
emergency obstetric services and continue to suffer from prolonged obstetric
labor which causes fistulas to occur. MSF provides treatment for fistula in
some countries where obstetric services are absent, inadequate, or in need of
support.
Maternal Health
The
percentage of deliveries assisted by qualified medical staff is 61 percent
worldwide, but this drops to 34 percent in developing countries. In Somalia and
Ethiopia, only 23 percent of deliveries involve qualified staff; in Haiti, it’s
5.6 percent. Without medical care, pregnant women are far more likely to die
from obstructed labor, eclampsia, the effects of malaria, or other conditions.
In
many countries and for a multitude of reasons, women deliver at home. In fact,
only 40 percent of deliveries worldwide take place in medical structures. And
in the countries where home-births are most common, maternal mortality is the
highest.
As
MSF is often the only health provider in a region, women frequently have to
travel long distances to reach us, and they may not begin this journey until
complications have already developed. In Ituri, for example, in eastern
Democratic Republic of Congo, more than one third of the 200 deliveries taking
place each month in the maternity ward of the Bon Marché Hospital present with
complications such as hemorrhage or eclampsia. In many countries where MSF
works, it provides care during pregnancy and prenatal consultations, emergency
obstetrics, and post-natal care. MSF also helps pregnant women identify a
nearby hospital so, as soon as labor begins, they know where to go.
Main Causes of
Maternal Mortality
The
main causes of maternal mortality are hemorrhage, sepsis, eclampsia, unsafe
abortion, and obstructed labor.
Hemorrhage,
or severe bleeding, accounts for a quarter of all maternal deaths. A woman,
even one in good health, who hemorrhages just after giving birth can die within
two hours, especially if she is left without obstetric care. Sepsis, or general
infection, is the main cause of death after delivery. One in 20 women giving
birth develops an infection requiring antibiotics to avoid potential
fatalities. Eclampsia is the world’s third most common cause of maternal
mortality. Eclampsia is linked to hypertension and is characterized by the
appearance of seizures that may lead to coma and death. According to the WHO,
there are approximately 70,000 cases of eclampsia each year in the 143
least-developed countries in the world. Convulsions related to eclampsia can be
prevented and treated using the drug magnesium sulfate.
Unsafe
abortion refers to the termination of an unintended pregnancy by persons
lacking the necessary skills, in an unhygienic environment, or both. One woman
dies every six minutes from unsafe abortion. Of those who live, many suffer
serious consequences such as infertility, or complications with future
pregnancies. Comprehensive sexual and reproductive health care services can
greatly reduce the number of unsafe abortions, by offering safer alternatives
through family planning and by identifying and treating complications during
pregnancy early on. Obstructed labor is another leading cause of death and
infirmity, particularly in sub-Saharan Africa and southeast Asia. It can also
cause rupture between the vagina-bladder wall and/or the vagina-rectum wall, a
condition known as obstetric fistula. Obstructed labor can be managed if it is
identified early, by following a woman in labor and intervening with medication
at the appropriate moment.