It is a startling and sobering fact that every minute of every day, a woman dies in pregnancy and childbirth somewhere in the world. This equates to more than half a million women dying in pregnancy and childbirth every year, with 99 per cent of these tragedies occurring in developing countries.
According to the United Nations Population Fund, the divide between rich and poor is truly alarming: in Africa, the lifetime risk of dying in pregnancy and childbirth is 1 in 22, in Asia it is 1 in 120 and in developed countries it is 1 in
7,300.
Maternal mortality across the developing world is therefore unacceptably high. Although most maternal deaths are preventable, satisfying the aim of Millennium Development Goal 5, to improve maternal health, is still proving extremely difficult. There is simply not enough being done to protect the health of mothers and infants in underserved, low- and middle-resource countries. In essence, poor women receive less care.
CLEAR TARGETS - DIFFICULT CHALLENGES
The targets are clear-sighted enough, and have been present on the global agenda for many years. The first target of Millennium Development Goal 5 is to reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio; the second is to achieve, by 2015, universal access to reproductive health. The survival of mothers across the globe is a major human rights issue. This critical ongoing priority within international development can be summarized in these crucial requirements: all women should be able to access contraception, including emergency contraception, to avoid unwanted pregnancies; all pregnant women need access to professional care at delivery; and all pregnant women experiencing complications need immediate access to quality emergency obstetric care.
THE NEED FOR SKILLED HEALTH CARE PROFESSIONALS
The majority of maternal deaths stem from the results of sepsis, severe bleeding, obstructed labour, eclampsia, and the consequences of unsafe abortion. Solutions are readily available, but innumerable barriers exist to thwart effective and timely prevention, and these can vary among cultures. A major hurdle in low-resource countries is a lack of access to skilled care professionals to perform essential interventions. Almost all maternal deaths could be averted if access to professional care during pregnancy, childbirth, and for a few weeks after childbirth were readily available.
ENABLING WOMEN'S FULL HUMAN AND?REPRODUCTIVE RIGHTS In addition to the lack of appropriate specialist care during and immediately after pregnancy, there are numerous other issues to take into account that could be called "pre-pregnancy factors". The 1994 International Conference on Population and Development, the largest intergovernmental conference on population and development ever held, had included in its Programme of Action a goal to make family planning universally available by 2015. Lack of access to contraception is indeed a major issue. In fact, a recent report from the Guttmacher Institute and the United Nations Population Fund has suggested that family planning can help reduce maternal deaths by 70 per cent, given appropriate global investment.
Other causes that impede women's ability to experience full reproductive rights and safe motherhood include poverty, gender inequity, illiteracy, nutritional taboos, and being subjected to harmful traditional practices such as female genital mutilation and child marriage. To sum up, it is clear that the socio-cultural environments of many developing countries do affect maternal and newborn health in a serious way. Firmly entrenched legal and political frameworks can put restrictions on women's abilities to make informed and safe choices about their reproductive health, leading to unfavourable consequences such as unsafe abortion and sexually transmitted diseases, including HIV/AIDS transmission.
THE SPECIAL ROLE OF HEALTHCARE PROVIDERS The International Federation of Gynecology and Obstetrics (FIGO), the only global body representing the world's gynaecologists and obstetricians, with member societies in 124 territories and countries, is doing robust work to help advance safe motherhood. Our main goals are to promote the health and well-being of women worldwide and to improve the practice of gynaecology and obstetrics. We work with global partners to address the critical and neglected issues of preventable maternal mortality and morbidity. The medical solutions are well known and are not beyond health providers' capabilities. We believe that capacity building of professional organizations to address the issues of human resources and sustainability is essential.
FIGO's current work includes several major projects to help implement policies to advance safe motherhood:
■ Maternal and Newborn Health Initiative | A grant from the Bill and Melinda Gates Foundation enables FIGO to help improve the lives and health of women and newborns in fifteen low- and middle-resource countries with high maternal and newborn mortality and morbidity. Countries in the first phase of the project are Burkina Faso, Cameroon, Ethiopia, Mozambique, Nigeria, Uganda, India and Nepal.
■ Saving Mothers and Newborns Initiative | The project builds and sustains the capacity of the obstetrician/gynaecologist and midwifery societies in Haiti, Kenya, Kosovo, Moldova, Nigeria, Pakistan, Peru, Uganda, Ukraine and Uruguay. The initiative conducts essential projects relevant to the promotion of safe motherhood and the improvement of maternal health, and also addresses maternal and newborn health priorities, especially in urban poor and rural areas.
■ Fistula Initiative | FIGO is piloting a groundbreaking competency-based training manual aimed at medical practitioners in low- and middle-income countries.
■ Prevention of Unsafe Abortion Initiative | Aims to reduce the global maternal mortality rate of 13 per cent related to unsafe abortions, according to the United Nations Population Fund. The initiative has been implemented in?fifty-four countries through FIGO member associations.
■ Adolescent Sexual and Reproductive Health Initiative | FIGO strengthens the capacities of its member societies to support Adolescent Sexual Reproductive Health interventions at the national level for adolescent sexual and reproductive health.
The robust work of FIGO's committees and working groups on, for example, Safe Motherhood and Newborn Health, Women's Sexual and Reproductive Rights, Fistula, Ethical Aspects of Human Reproduction, and Women's Health and Prevention of Unsafe Abortion helps to keep health practitioners at the cutting edge of developments and to treat women with dignity and respect.
THE GLOBAL CAMPAIGN ? -- KEEP WORKING WITH THE EVIDENCE With maternal mortality still unacceptably high, global responses must continue to acknowledge the significant percentage of deaths arising from pregnancies of young women, the trend of early marriage, unsafe abortion, and medicalization of female genital mutilation. High child, infant, and neonatal mortality is also related, as is malnutrition in children. There is still a significant unmet need for contraception, which would appear to be the fastest, most cost-effective approach to reducing maternal death, in turn greatly benefiting families, labour forces, and health structures.
Considerably more needs to be done in advancing efficient, safe, and effective policies, and FIGO's essential work continues to improve maternal and newborn health, and reduce mortality and morbidity.
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