MDG5: Improve maternal health - Professor Oona Campbell, LSHTM Tue, 2009-06-30 02:04

Delivering a baby can be a time of great celebration, but is also a time of great risk. Two-fifths of maternal deaths occur from the start of labour until 24 hours later. Every minute a woman dies in childbirth or from complications during pregnancy. The current slow progress in achieving MDG 5?s target to reduce maternal mortality by three-quarters requires us to speed up the provision of good quality delivery care. There are also huge differences in coverage of such care between and within countries. Maternal mortality is the public health indicator with the greatest gap between rich and poor countries, with 99 per cent of deaths in the developing world. Even in poor countries, the richest women have much greater access to services than rural women. The potential gains from expanding quality delivery facilities are enormous and extend to improvements in neonatal survival. We need to renew our commitment to meeting this priority.

Millennium Development Goal 5: Improve maternal health

Professor Oona Campbell, of the London School of Hygiene and Tropical Medicine (LSHTM), described progress towards MDG5, which aims to reduce maternal mortality by three-quarters, as “severely off-track” when she addressed LIDC’s conference on 5 November. She set out the stark reality of the high levels of maternal death in the developing world during the event called No Goals at Half-time: What Next for the Millennium Development Goals?

Large problem of maternal death
Campbell explained how a woman dies in childbirth or from complications during pregnancy every minute, day in and day out. She illustrated how most deaths occur during labour or within 24 hours after delivery, and how excessive bleeding is the main cause of death. Campbell also showed how maternal mortality is the public health indicator with the greatest gap between rich and poor countries – 99 per cent of maternal deaths are in the developing world. The poorest in developing countries are the hardest hit. For example, the richest quintile in Peru have a maternal mortality rate eight times lower than the poorest quintile. Campbell emphasised the tragedy of the situation by saying that most maternal death is preventable. In the UK, for instance, more men die of breast cancer than women die in childbirth and pregnancy. Moreover, she said the financial resources devoted to achieving MDG5 and MDG4 have not been adequate and relatively more money has been spent on tackling HIV/AIDS, tuberculosis and malaria (MDG6).

Reducing maternal death
Campbell continued by detailing the strategies that reduce maternal mortality and showing how they can be improved. Better family planning services are a priority, particularly in sub-Saharan African where 24 per cent of married women had an unmet need for contraception between 2000 and 2005. Delivery care is also “paramount” and Campbell said the ideal is for all women to be attended by an appropriate health professional – a midwife or doctor. Currently half the world’s births are attended by a health professional. In South Asia and sub-Saharan Africa most urban women deliver with a health professional, but only a third of rural women do so. Campbell highlighted how the supply of health professionals needs to increase by 300,000 (which would mean a doubling by 2015) because of the shortage of human resources. There is also a need to retain existing staff, provide training and housing, and set up 24,000 health centres. Campbell stressed the need to understand the mechanisms of delivering interventions and improving health systems.

Links with other MDGs
The inextricable connections between MDG5 and many of the other MDGs were explored in the presentation. Campbell mentioned that MDG5 is closely related to the MDGs referring to poverty reduction (MDG1), female empowerment (MDG3), child survival (MDG4) and disease (MDG6). She concluded by saying progress is possible and cited sustained declines in maternal mortality in Sri Lanka, Thailand and Malaysia. She said: “Health centre strengthening is key. Too many women are still dying in their prime”.

Professor Oona Campbell is a reproductive epidemiologist and leads the Maternal Health Programme at LSHTM. Her expertise includes measurement of maternal morbidity and mortality, perinatal mortality and evaluation of different modes of delivering maternal health and family planning services. Her current research includes examining Vitamin A intake to reduce maternal mortality in Ghana. She is a member of Towards 4 and 5, a DFID-funded research programme focusing on MDGs 4 and 5.