Maternal and newborn health
Across Eastern and Southern Africa (ESA), women are still dying unnecessarily during the most basic and natural act of giving life. In 2010, close to 58,000 women lost their lives in pregnancy and childbirth, accounting for more than one fifth of all such deaths in the world. That’s close to 10 deaths every hour!
Of the region’s 21 countries, 16 have high maternal mortality rates (300 or more maternal deaths per 100,000 live births). In Somalia, a woman’s lifetime risk of dying from maternal causes is 1 in 16, a close second to Chad’s 1 in 15 – the highest in the world.
Thanks to national and international efforts, the past two decades have witnessed a worldwide downward trend in maternal deaths. In ESA, between 1990 and 2010 maternal mortality has fallen from 740 to 410 deaths per 100,000 births. However, the pace of progress is far too slow.
Only Eritrea is on track to reach MDG 5, reducing maternal deaths by three-quarters by 2015. Angola, Comoros, Ethiopia, Madagascar, Malawi, Mozambique, Rwanda, Tanzania and Uganda are making progress (annual average decline of 2-5.5 per cent); while the other countries are making insufficient (less than 2 per cent) or no progress at all (an annual increase).
Hemorrhage is by far the leading cause of maternal deaths; along with hypertension, which accounts for more than half of all maternal deaths. HIV-related illnesses also play a major role in maternal deaths, especially in Southern Africa where HIV prevalence is high.
Many maternal deaths could be avoided if mothers were attended at birth by skilled health professionals, and if essential supplies, equipment and facilities were available. Yet, more than half of all births in the region take place without the support of a skilled birth attendant. In Ethiopia, for example, 90 percent of women deliver their babies without the help of any trained health professional.
Across the region, there is also a significant disparity between rich and poor population groups when it comes to skilled birth assistance. In Botswana, for example, where 95 per cent of all births are assisted by skilled attendants, the rate is much lower for the poorest 20 per cent of the population than the richest 20 per cent (84 and 100 per cent, respectively).
In most of sub-Saharan Africa, including ESA, neonatal mortality has seen no significant change in over a decade. Nearly 4 in 10 under-five deaths are among newborns up to 28 days of age, making neonatal mortality reduction increasingly the ‘unfinished business’ of under-five mortality reduction. Ethiopia, Tanzania, Uganda, Kenya, Angola, Mozambique, Somalia and South Africa, account for 75 per cent of all neonatal deaths in the region.
Both neonatal and maternal mortality are heavily concentrated around the period of delivery and the first week after birth. Most of these deaths occur at home, from complications during birth and those related to preterm birth.Two-thirds of such deaths could be saved if mothers and babies were attended by trained health professionals, who could help babies breathe; instruct their mothers to keep them warm; teach them how to stave off infections such as neonatal tetanus; help mothers exclusive breastfeed; and refer sick newborns for treatment in a timely manner.
UNICEF in action
The lack of progress in reducing maternal and newborn mortality is largely due to poor health and social infrastructure, weak service delivery, and a shortage of qualified health workers. Compared to their well-off peers, the poor populations are more deeply affected by these challenges. UNICEF’s analyses consistently show that the indicators in maternal and neonatal mortality reflect the greatest and most persistent health inequity worldwide.
Responding to this dire situation, in 2008, four UN agencies, WHO, UNFPA, World Bank and UNICEF, committed themselves to harmonizing their approaches to improve maternal and newborn health at country levels. With the recent joining by UNAIDS and UN Women, the partnership is now referred to as UNH4+. Nine countries in ESA, Ethiopia, Kenya, Malawi, Mozambique, Rwanda, Uganda, Tanzania, Zambia and Zimbabwe, have been prioritized for action because their maternal and neonatal health indicators are among the worst in the world.
In 2010, the fight against child and maternal mortality received a renewed boost, with the launch of the Every Woman Every Child (EWEC) movement and the Global Strategy for Women’s and Children’s Health by the UN Secretary-General Ban Ki-moon. These efforts focus on mobilizing commitments by government, civil society organizations and development partners to accelerate progress towards reaching MDGs 4 and 5.
In 2012, the publication and launch of ‘Born too Soon: the Global Action Report on Pre-term Births’ drew attention to pre-term births, now the second biggest killer of children under-five after pneumonia. The report provided the first-ever national, regional and global estimates of pre-term births. In June 2012, the governments of Ethiopia, India, and the United States, with UNICEF, co-convened ‘Committing to Child Survival: A Promise Renewed’ - a global movement to accelerate action on maternal, newborn and child survival, highlighting the need for action to combat neonatal deaths.
Furthermore, the Ministerial Communique on Lifesaving Commodities, a follow up to the UN Commission on Lifesaving Commodities (UNCoLSC) report and implementation plan (October 2012), commits governments to increase access to life-saving medicines and health supplies for the world’s most vulnerable people.
Results for children
Across ESA there is now a clear understanding of when, where and why mothers and newborns are dying. The crisis of human resources in health, particularly the shortage of skilled midwives, together with weak community-health delivery systems, and the limited provision of community-based maternal and newborn care are calling on UNICEF and the UNH4+ partnerships to continue putting maternal and newborn health high on the agenda.
More on maternal and newborn health