Target by 2015:
Reduce the maternal mortality ratio by three quarters.
Healthy children need healthy mothers.
A woman dies from complications in childbirth every minute – about 529,000 each year -- the vast majority of them in developing countries.
A woman in sub-Saharan Africa has a 1 in 16 chance of dying in pregnancy or childbirth, compared to a 1 in 4,000 risk in a developing country – 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% of the burden of disease in children below the age of 5 is related to poor maternal health and nutrition, as well as quality of care at delivery and during the newborn period. And yearly 8 million babies die before or during delivery or in the first week of life. Further, many children are tragically left motherless each year. 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 stabilised at very high levels, continues to be a major problem, with up to 45 per cent of HIV-infected mothers transmitting infection to their children. Further, HIV is becoming a major cause of maternal mortality in highly affected countries in Southern Africa.
A majority of these deaths and disabilities are preventable, being 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 these women's lives – and those of their children.
UNICEF responds by:
Helping improve emergency obstetric care. Almost half of births in developing countries take place without a skilled birth attendant. That ratio rises to 65 per cent in South Asia.
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 that transport is available to referral services, and that quality emergency obstetric care is available. UNICEF works with the United Nations Population Fund (UNFPA), the World Health Organization (WHO) 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 (PRSPs) and Sector-Wide Approaches (SWAps), and assists its partners and governments with assessments, training and logistics.
Laying the foundations for good prenatal care. Out of 100 women aged 15-40, 30 do not have antenatal care – 46 in South Asia and 34 in sub-Saharan Africa. The results of this deficiency include untreated hypertensive disorders leading to death and disability, or unmarked mal- or sub-nutrition. Iron deficiency anaemia among pregnant women is associated with some 111,000 maternal deaths each year. Some 17 per cent of infants in developing countries had low birth weight in 2003,and these babies are 20 times more likely to die in infancy.
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. Tetanus, a bacterial disease that’s a result of unhygienic and unsafe childbirth delivery practices, killed 200,000 newborns and 30,000 mothers in 2001 alone. Along with buying and helping provide tetanus immunizations for pregnant women, UNICEF provides micronutrients to stave off anaemia and birth defects – all of which lead to healthier mothers and babies.
Helping prevent mother-to-child transmission of HIV. From 1998, UNICEF on behalf of other UN partners has been providing country support for prevention of mother-to-child transmission (PMTCT) programmes within existing maternal and child services in resource-poor settings. This includes advocacy on distributing ARV to young women and parents with HIV/AIDS as part of UNICEF's support of the “3 by 5 Initiative” program with the World Health Organization, which aims to ensure that 3 million people have access to antiretroviral treatment by the end of 2005.
Services may 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, a UNICEF priority, also benefits maternal and infant health – particularly education for girls. Educating girls for six years or more drastically and consistently improves their prenatal care, postnatal care and childbirth survival rates. Educating mothers also greatly cuts the death rate of children under five. Educated girls have higher self-esteem, are more likely to avoid HIV infection, violence and exploitation, and to spread good health and sanitation practices to their families and throughout their communities. And an educated mother is more likely to send her children to school.
Data on skilled attendants at delivery is available for only 74 per cent of live births in the developing world. The evidence we do have shows that, apart from Sub-Saharan Africa, delivery care has improved significantly in all regions, though not all countries have shared equally in improvements. Only 17 per cent of countries are on track to meet their Goals.
In developing countries as a whole, the per cent of births attended by a skilled health professional has increased by more than a quarter - that is, from 42 per cent to 53 per cent over the decade. From 1990 to 2000, the percentage of births attended by a medical professional in Asia rose 35 per cent. Unfortunately, in Sub-Saharan Africa where maternal mortality is highest, the levels have improved only 5 per cent.
Since 1999, 32.7 million women at risk have been protected against tetanus by a two-dose course. And UNICEF is now working in 158 countries for girls’ education.
By the end of 2004, more than 100 countries had established PMTCT programs, of which 13 had achieved national coverage.