Goal: Improve maternal health

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Target by 2015:
Reduce the maternal mortality ratio by three quarters.

Healthy children need healthy mothers.

A woman in sub-Saharan Africa is hundreds of times more likely to die in pregnancy or childbirth than one in an industrialized nation – the largest difference between poor and rich countries of any health indicator.

This glaring disparity is reflected in a number of global declarations and resolutions. In September 2001, 147 heads of states collectively endorsed Millennium Development Goals 4 and 5: To reduce child mortality rate by 2/3 and maternal mortality ratio by 3/4 between 1990 and 2015. Strongly linked to these is Goal 6: To halt or begin to reverse the spread of HIV/AIDS, malaria and other diseases.

The direct causes of maternal deaths are haemorrhage, infection, obstructed labour, hypertensive disorders in pregnancy, and complications of unsafe abortion. There are birth-related disabilities that affect many more women and go untreated like injuries to pelvic muscles, organs or the spinal cord. At least 20 percent of the burden of disease in children below the age of five is related to poor maternal health and nutrition, as well as quality of care at delivery and during the newborn period. Every year, millions of babies die before or during delivery, or in the first week of life. Further, many children are tragically left motherless. These children are 10 times more likely to die within two years of their mothers' death.

Another risk to expectant women is malaria. It can lead to anaemia, which increases the risk for maternal and infant mortality and developmental problems for babies. Nutritional deficiencies contribute to low birth weight and birth defects as well.

HIV infection is an increasing threat. Mother-to-child transmission of HIV in low-resource settings, especially in those countries where infection in adults is continuing to grow or has stabilized at very high levels, continues to be a major problem. Further, HIV is a cause of maternal mortality in highly affected countries in Southern Africa.

A majority of these deaths and disabilities are preventable, since they are mainly due to insufficient care during pregnancy and delivery. About 15 per cent of pregnancies and childbirths need emergency obstetric care because of complications that are difficult to predict.

Access to skilled care during pregnancy, childbirth and the first month after delivery is key to saving the lives of women who face these risks – and the lives of their children.

UNICEF responds by:

Helping improve emergency obstetric care. Research shows the single most important intervention for safe motherhood is to make sure that a trained provider with midwifery skills is present at every birth. It's also critical that transport to referral services is available and that women have access to quality emergency obstetric care. UNICEF works with the United Nations Population Fund, the World Health Organization and other partners in countries with high maternal mortality in a well-defined supporting role as part of an emerging global partnership for maternal, newborn and child health.

UNICEF also helps work with policy makers to ensure that emergency obstetric care is a priority in national health plans, including Poverty Reduction Strategy Papers and Sector-Wide Approaches, and assists its partners and governments with assessments, training and logistics.

Laying the foundations for good prenatal care. With advocacy, technical help and funding, UNICEF helps local communities provide information to women and their families on signs of pregnancy complications, on birth spacing, timing and limiting for nutrition and health, and on improving the nutritional status of pregnant women to prevent low birth weight or other problems.

A comprehensive community programme also promotes and helps provide anti-malarial therapy and insecticide-treated bed nets. Along with buying tetanus vaccine and helping to provide tetanus immunizations for pregnant women, UNICEF provides micronutrients to stave off anaemia and birth defects. All of these interventions lead to healthier mothers and babies.

Helping prevent mother-to-child transmission of HIV. UNICEF provides country support for prevention of mother-to-child transmission (also known as PMTCT) programmes within existing maternal and child services in resource-poor settings. This includes advocacy on distributing anti-retroviral medicines to pregnant and lactating women and their babies. Services also include voluntary and confidential counselling and testing for HIV/AIDS. If an expectant mother has the virus or AIDS, she is counselled on how to help prevent transmitting the disease to her child, including safer breastfeeding practices.

Getting girls to school. Helping governments provide a quality primary school education – particularly education for girls, a UNICEF priority – also benefits maternal and infant health. Educating girls for six years or more consistently improves their prenatal care, postnatal care and childbirth survival rates later in life. Educating mothers also greatly cuts the death rate of children under five. Educated girls have higher self-esteem and are more likely to avoid HIV infection, violence and exploitation, and to spread good health and sanitation practices to their families and communities. And an educated mother is more likely to send her children to school.

See map: Girls’ education improves maternal health

Progress

The available data indicates that the availability of skilled birth attendants has improved significantly in all regions apart from sub-Saharan Africa, where the improvement has not been as great. However, not all countries have shared equally in the improvements, and most are not on track to meet their maternal health Goals.

Multimedia feature:  Tracking maternal, newborn and child survival

Read Thematic Paper on MDG 5: Improve maternal health [PDF]