Goal 5 Improve maternal health

HealthcareMaternal Healthcare

One of the targets for this goal is to reduce by three quarters the number of women dying in childbirth.

Helping women in labour

Over 50 million women give birth each year without help. Each year nearly 600,000 women die worldwide from preventable complications during pregnancy or childbirth, 99% of them in the South.

The most common causes of death are:

  • 25% haemorrhage (excessive bleeding)
  • 15% infection
  • 13% unsafe abortions
  • 12% eclampsia (a dangerous condition of late pregnancy with high blood pressure and fits)
  • 8% obstructed labour.

Young mothers under 20 years of age are five times more likely to die during childbirth. Two million girls undergo some form of female genital mutilation each year, which considerably increases the likelihood of infection and complications during childbirth.

In addition to the women who die, there are also many thousands who are left damaged or infertile after childbirth. Long and difficult labour may result in obstetric fistula. If the baby’s head presses for many hours on the bladder and rectum, they may develop holes so that after birth, the woman leaks urine and sometimes faeces. They face a life of shame, often rejected by their family and unable to remove the smell of urine or faeces. In Africa, MaterCare estimates that two million women need surgery to repair obstetric fistulas but there are few hospitals and health centres able to provide this surgery.

Traditional birth attendants

Traditional birth attendants (TBAs) can be trained to support mothers in labour and reduce infection. Training them to wash their hands, clean surfaces and cut the umbilical cord with a new razor blade (or with a sharp knife or scissors boiled for 20 minutes before use) will considerably reduce the risk of infection. TBAs can also be trained to recognise women likely to need additional medical care and to refer complicated births to hospital.

However, research in Pakistan (by Health-Pakistan) has shown that the impact of TBAs is only likely to save 3% of the women who die during childbirth. Many more lives could be saved if women had good access to emergency care and skilled medical help if their deliveries develop complications.

Recent research shows that the following are the most effective ways of reducing deaths from childbirth:

Better education for girls Girls who finish primary school are much more likely to have fewer children and to give birth to them later in life. They are also much more likely to seek antenatal care and to have healthy babies.

Trained midwives TBAs provide good support for women who have uncomplicated births and reduce the likelihood of infection. However, trained midwives, who can help when the birth is complicated, are much more important in saving lives.

Emergency medical care Difficult births will need rapid referral to a suitably equipped health centre or hospital to save the lives of mothers and their babies.

Other ideas to meet Goal 5 

  • Community nutrition programmes for pregnant women which include zinc and vitamin A supplements.
  • Training for TBAs and for community midwives.
  • Raise awareness of the risks of female genital mutilation.
  • Ensure all girls complete primary school education.
  • Lobby for surgery to be available for women suffering from obstetric fistulas.

Progress on Goal 5

So far there has been little progress towards achieving this goal.

Taking action in our community

Develop a role play about a young mother giving birth to her first baby.

At first, show lots of excitement among friends and relatives. Some women and a TBA arrive to help her. The hours pass…

The birth is obviously not going well and she needs emergency help – available five miles away in a health centre. The father and elders meet that evening to discuss where to find transport. Eventually they telephone a relative in the nearby town who will find a truck and bring it. Then they discuss how to find the money. Two people go off to visit relatives to borrow money. In the meantime the women are more and more worried.

By midday the next day, the truck arrives and they manage to borrow money. But the woman is now completely exhausted from the long labour. She dies as they prepare to move her. Everybody asks ‘Why did it take so long to find transport and funds?’

Conclude the role play as people agree to set up a community health committee with responsibility to provide emergency transport (using a stretcher and volunteers) and to manage a small loan fund for families of all women in labour. 

Discussion questions

  • What access do women in our community have to emergency healthcare?
  • Where is the nearest hospital or health centre with skilled medical staff?
  • What does it cost to deliver a baby there?
  • Are there any midwives or doctors willing to come to our community and assist in difficult births?
  • How much does their service cost?
  • How could our community establish a good system to provide emergency transport for women who have problems during labour?
  • Could an emergency fund be established for medical emergencies? How could it be effectively managed and replaced after each use?
  • Do mothers go for ante-natal care so that at-risk deliveries can be identified early?