October 17, 2021 | by Julia Masselos
What is Maternal Health?
Maternal health is a term used to refer to the health of a woman during pregnancy, childbirth, and the postpartum period – which can last up to 6 months after the birth of the baby. This is not to be confused with the perinatal period, which lasts from 22 weeks gestation until 7 days after childbirth.
The overall health of the mother leading up to and during pregnancy can have a profound effect on the pregnancy itself, but also on the newborn infant’s health and development into childhood, adolescence and adulthood. Lifestyle factors including a healthy diet, physical activity levels, whether the mother is a smoker, using illicit drugs, and levels of alcohol consumption can all play a pivotal role in determining the likelihood of the newborn developing chronic conditions later in life.
It is known that there are certain factors that correlate with lower maternal health, such as socioeconomic status (poverty has been repeatedly linked with lower reproductive health), adequate access and uptake of maternal health facilities, and particularly, antenatal care (ANC). In 2016, the WHO developed guidelines for ANC – which serves as a platform to facilitate more positive pregnancy experiences, providing early management and intervention when things go wrong, and eventually saving lives.
Why is Maternal Health Important?
Maternal health is a vital indicator of global health and development, making it a core public health issue affecting countries around the world. There are still too many mothers and newborns dying from entirely preventable causes – about 800 mothers per day, according to the CDC.
In 2012, 6.6 million children died before the age of 5 – 76% of them dying in the first year of life. Pneumonia and diarrhea are the prime culprits of neonatal death – diseases that are perfectly treatable in better-resourced countries. Given this, it is perhaps unsurprising that 99% of these maternal and neonatal deaths occur in developing countries, indicating that lack of adequate access to the necessary facilities are leading to this crisis of maternal and neonatal health.
Of course, like any public health issue, things are not as simple as that. There are many other factors at play, including socioeconomic status, education level, past experiences with the local healthcare system, lifestyle factors, and other social determinants of health.
For example, Black women are four times more likely to die in childbirth than white women. This is not news. Racial and ethnic disparities in pregnancy-related deaths have persisted over time. American Indian (AI) and Alaska Native (AN) women over 30 years of age experience four to five times the level of death per 100,000 live births as white women of the same age.
Despite inequities that initially seem comparable, it is important to not brush all minorities with the same brush. Indeed, according to a recent CDC study, different minorities contend with different kinds of complications, indicating that the way out of this disparate maternal survival rate is not with a one-size-fits-all solution. The study found that Black women deal with cardiomyopathy, thrombotic pulmonary embolism, and hypertensive disorders of pregnancy, while AI and AN populations experienced higher rates of hemorrhages and hypertensive disorders of pregnancy.
Maternal Health around the World
According to the WHO, 295,000 women around the world died during or shortly following pregnancy or childbirth in 2017. 94% of these deaths were in low- and lower-middle-income countries, with 86% of these being concentrated in Sub-Saharan Africa and South Asia. For context, maternal mortality rates in high-income countries stands around 11 per 100,000, compared to 462 per 100,000 in low-income countries.
The most common causes of maternal death are excessive blood loss, infection, high blood pressure, unsafe abortion, and obstructed labour. Other indirect causes of maternal poor health and death include anemia, malaria, and heart disease.
Most of these issues are preventable with proper, timely management by competent health professionals. Because of this, maternal health is used as a sign of global health and development.
However, not all is doom and gloom. In fact, from 2000 to 2017, the maternal mortality rate fell by 38% globally. This number balloons significantly if high-income countries where minimal gains were made (due to an already low maternal mortality rate) are excluded. Maternal mortality in South Asia fell by 60% in the 17 year period. Similar gains were seen in Sub-Saharan Africa (40%), while Central Asia and East Asia both halved their maternal mortality rate.
Maternal Health as an Indicator of Global Development
To understand that maternal health is an indicator of global development and public health is to understand that we are only as good as our weakest link. In other words, whatever access to maternal healthcare our most under-resourced communities have, indicates how successful we are at ensuring maternal health for all. Making improvements in the most resource-poor areas would lead to huge gains on global averages.
Women in remote areas with limited finances are the least likely to receive the necessary healthcare when pregnant and in the following weeks and months. This is particularly the case for remote regions when there is also a shortage of skilled health workers.
For example, most high- and upper-middle-income countries benefit from having a trained midwife, nurse, or doctor present at 90% of all births. By contrast, less than half of all births in low- and lower-middle-income countries receive the same kind of medical support.
Some of the factors preventing women from seeking or receiving adequate care during pregnancy and childbirth include, but are by no means limited to:
Barriers that limit access to quality maternal health services must be identified, addressed, and alleviated at both the levels of the health system and society.
However, it is important to note that even within high-income countries, great disparities exist in maternal health. Between 2011 and 2014, the maternal mortality rate among Black American women was 40 in 100,000 live births, compared to just 12 in 100,000 for white American women.
In fact, the disparity in health outcomes for different groups is so stark, that in 2008, human rights groups around the world began calling on the U.S. to do more to keep its mothers from dying. The US government was again called out in 2012, this time by Amnesty International, for not taking the necessary steps to curtail this inequality.
This shows just how systemic and entrenched maternal health is with wider social norms and the behavior of the people who operate within the nation. Black women are more likely to be dismissed by doctors, have their symptoms belittled, or be refused pain medication (or at least be given a weaker dose).
So where does this leave us? It seems clear that the only meaningful way to drastically reduce maternal mortality is to address the structural factors at play around accessing adequate medical care. Indeed, this is exactly what a 2015 study found.
Published in the journal of Global Health, it concludes, “…decreasing maternal mortality requires dealing with various factors other than individual determinants including political will, reallocation of national resources (especially health resources) in the governmental sector, education, attention to the expansion of the private sector trade and improving spectrums of governance. In other words, sustainable reduction in maternal mortality (as a development indicator) will depend on long-term planning for multi-faceted development. Moreover, trade, debt, political stability, and strength of legal rights can be affected by elements outside the borders of countries and global determinants.”
Improving Maternal Health: The Role of Tech
Historically, and even currently, several global NGOs like the WHO, the UN, and others have taken the lead in orchestrating policy, suggestions, goals, and guidelines for improving global maternal health. The UN Sustainable Development Goal addressing the reduction of maternal mortality rates to 70 in 100,000 worldwide is one such example.
However, more recently, several start-ups and tech companies have entered the health space, providing services such as better infrastructure, or digital tools for medical staff to track health, manage patient data, or give prescriptions.
One example of this is MOTECH, who, in partnership with HITLAB, scaled up a mobile messaging tool to support pregnant women in Ghana. Mobile technology has the incredible potential to deliver healthcare solutions globally, especially in locations where computer or WiFi accessibility might be limited. Inspired by the innovative potential of mobile technology solutions, MOTECH uses mobile phones to increase the quantity and quality of antenatal, postnatal, and neonatal care in Ghana.
Conclusion
Summing up, maternal health is an incredibly important marker of a country’s public health system. More important than its role as a global development indicator is the impact positive maternal health has on societies. Physically and psychologically healthier children, more economically prosperous people, and happier livelihoods.
Disparities in maternal health are seen between more and less well-resourced countries, but also within single countries – for example between white and Black women in the United States. This points to the need for a long-term, top-down approach to tackling inequalities in pre- and post-natal care. Recent developments of technology have allowed progress to permeate even the most remote regions, and if we keep up this trend, we will continue to decrease maternal mortality across the world and provide better healthcare for women everywhere.
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