Evidence That Is Saving Mothers’ Lives

A nurse by training, Charlotte Warren leads maternal and newborn health research for the Population Council. She argues for evidence-based action to reduce deaths through the detection and management of eclampsia and pre-eclampsia and ending physical abuse during childbirth.

Written by Charlotte Warren Published on Read time Approx. 3 minutes
A 36-year-old Palestinian mother, Abeer, right, sits near her daughter, 19-month-old Anwar Saad, at their family home in Gaza CityAP/Khalil Hamra, File

My first job in Africa was as a nurse in a refugee camp in eastern Sudan, where I managed feeding centers for thousands of malnourished children. One memory that has stayed with me over the years is seeing a tiny baby whose mother wasn’t healthy enough to produce sufficient milk, so the other mothers were donating their breast milk to feed the baby.

That was when it became clear to me: Child and maternal health are intimately linked. When mothers die, their infants are much more likely to die too – and the numbers are staggering: More than 830 women die every day from preventable causes related to pregnancy and childbirth, and 2.9 million infants die in their first month of life.

These are not just numbers: Each one is a heartbreak. Together, we have brought the tally down sharply in the past few decades with determined action, but we must and can do more – and we must do it at a time of competing demand for ever-reducing resources.

Nearly all maternal and child deaths occur in developing countries, where mothers and children often don’t get the care they need, with nearly two-thirds of pregnant women lacking adequate antenatal care. A lack of knowledge about what works for women frequently leads to providers who are poorly trained, ill equipped or both, while barriers due to poverty, communication, culture and transportation may prevent pregnant women from getting to healthcare providers in the first place.

For more than a decade, the Population Council has been working to address these challenges by improving health providers’ ability to identify and prevent major causes of death in pregnant women, including the rapidly increasing blood pressure of pre-eclampsia and eclampsia or the seizures that can follow. This is the second leading cause of maternal death worldwide and is responsible for one-quarter of preterm deaths.

Early detection and appropriate management of pre-eclampsia and eclampsia (PE/E) can prevent these maternal deaths, mainly through the proper use of antihypertensive drugs to control high blood pressure, and magnesium sulfate – an effective, safe, low-cost drug that controls seizures in pregnancy when administered at the first signs of severe PE/E. The Population Council’s Ending Eclampsia project is expanding access to these underutilized interventions and resources, working with the U.S. Agency for International Development, health ministries and professional groups to overcome barriers to women receiving appropriate preventive treatment and care due to policy, cost and access in Bangladesh, Ethiopia, Nigeria and Pakistan.

However, other critical issues affect women with limited access to comprehensive maternity care. An estimated 2 million women live with obstetric fistula and cannot control leakage of their urine and feces. Barriers to care continue to exist and many women do not seek treatment due to social and cultural issues and health system-led weaknesses.

But access to treatment and care is not the only thing that stands in the way of ensuring a safe pregnancy and delivery. Nearly half of pregnant women in the developing world give birth without skilled care throughout labor and delivery, many because of lack of access, but also due either to the experience of fear, mistreatment or abuse, or disrespect from overworked and underprepared healthcare providers.

The Council’s Heshima project researched mistreatment by health workers in Kenya and how fear of ill-treatment discourages women from seeking skilled childbirth help. For three years our researchers documented discrimination, betrayed confidence, physical abuse and disrespect. Our findings contributed to a legislative proposal and changes in health system policy to combat the situation. The Council’s evidence and analysis made a significant contribution to the development of WHO’s global statement on the Prevention and Elimination of Disrespect and Abuse During Childbirth in 2014. This statement illustrated the commitment of governments to highlight the rights of women and to promote access to safe, timely, respectful care during childbirth.

Our instinct is to trust healthcare providers, but the evidence from our studies tells a different story. Documenting and exposing abuse proves not only that it happens, but that it also contributes to turning women away from seeking care. By documenting and publicizing disrespect and abuse within health systems, we are able to provide hospital administrators and policymakers with recommendations that address the issue. However, we should not forget the tremendous work of most front-line health workers who provide quality maternal and newborn healthcare in very stressful situations – constrained by weak health systems and poor management.

We must use this moment at the Women Deliver conference to ensure that women and children get the gender equality and access to basic healthcare they deserve. Ensuring that all pregnant women and newborns receive adequate care would cut the death rate for mothers worldwide by 68 percent and for newborns by 77 percent, according to the World Health Organization. Evidence-based action is the only kind we can now afford, and we must invest only in programs backed by solid proof that they work.

The views expressed in this article belong to the author and do not necessarily reflect the editorial policy of Women and Girls Hub.

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