Childbirth is a universal phenomenon; the arrival of a child being a time of joy and celebration. Nevertheless, unlike the ubiquity of childbirth, there is an extreme disparity in the emotions that accompany pregnancy and childbirth. This, in consequence, showcases the inequality in maternal health and mortality that exists within the world. When comparing developed and developing countries or even deprivileged areas within countries, it is evident that the rates of maternal mortality vary considerably; the differing level of care and services leading to astonishing high mortality rates in low-income countries in comparison to high-income countries.
In 2000, the United Nations planned to work towards a series of goals termed the Millennium Development Goals (MDGs) which aimed to achieve a three-quarter reduction in the 1990 maternal mortality ratio, maternal deaths per 100 000 live births, achieve universal access to reproductive health, improve maternal health, and improve child health (World Health Organization 2015). Building on the MDGs, the Sustainable Development Goals (SDGs) established a transformative agenda for maternal health towards ending preventable maternal mortality (World Health Organization 2015). Worldwide measures of maternal mortality from 2000 to 2015 were taken and assessed, providing for a trend and an assessment of the MDG and SDG targets. The results showed that, globally, there was an overall decrease in maternal mortality, falling by nearly 37% over the past 15 or so years. Specifically, the global maternal mortality ratio decreased from 341 per 100,000 live births in 2000, to 216 in 2015 (Alkema et al. 2016). Overall the approximate lifetime risk of a maternal death fell considerably from 1 in 73 to 1 in 180 in 2015 (World Health Organization 2015). Particular countries account for a large percentage of the global maternal deaths and despite the global downward trend, the magnitude of mortality reduction differs between regions with some not even achieving decreased mortality rates. Developing regions accounted for nearly 99% of the global maternal deaths in 2015, with sub-Saharan Africa accounting for about 66%. The greatest decline over this time period was observed in Eastern Asia (decreased by 72%), with sub-Saharan Africa and Oceania, in 2015, being reported as regions with the highest maternal mortality rates (World Health Organization 2015).
The reason to why some regions in the world still show quite high deaths of pregnant women can be attributed to conditions that present as challenges to reducing maternal mortality. Taking the goals set out by the UN in perspective along with Jerker Liljestrand’s article, Reducing perinatal and maternal mortality in the world: the major challenges, the challenges can be either linked to the inability of the international organizations or political system to have an adequate effect in these regions or due to the social and cultural systems. For example, in regions that are facing constant conflict, with people displaced from their war-torn homes and health care being inaccessible, the maternal mortality ratio remains high due to the inability of humanitarian efforts and medical aid to be accessed by expectant mothers. Breakdown of political and health systems due to conflict can cause a dramatic rise in deaths due to complications that would have otherwise been easily treated under stable conditions (World Health Organization 1989). Developing countries also do not have adequate infrastructure, resulting in a lack of sufficient medical centres to service a large population. Further, these countries also possess a largely poor sub-population, whose poor nutritional status and decreased knowledge of or access to medical resources results in the prevailing high maternal mortality for the country. On the other hand, despite organizational efforts, the prevailing social and cultural norms hinder the reduction of maternal mortality. Being East Asian and having had first hand exposure to the health care in regions like India, that hold one of the highest mortality ratios in the world, there are few things that I would consider to be the reasons why such unnecessary deaths in these regions continues to take place. In many high mortality countries, the female is deprived from an education and a voice. She is suppressed in her ability to voice concerns or change whether it be for political change or even in her decision to not have any more children. Further, ideas such as contraception and family planning and the reality of sexually transmitted infections are frowned upon, consequently placing women in avoidable medical emergencies and raising the rates of maternal mortality.
Given the challenges that we still face in reducing maternal mortality worldwide, there are many strategies that can be employed to successfully reach the proposed Millennium Developmental Goals. Primarily, for the largely populated regions, improving access to medical services would be a largely effective strategy. Increasing the number of adequately staffed centres, having the centres open for longer periods of time, and decreasing the distance between the centre and the target population would greatly enhance the delivery of valuable medical services to expectant mothers. International efforts can be made to allow for the building of more centres and incentives can be placed for nurses and doctors to attract them to provide their services at these locations (Padmanaban et al. 2009). In terms of overcoming the cultural or social barriers to reducing maternal mortality, knowledge would be the best form of intervention. Information should be provided in a comprehendible and approachable manner regarding contraception and its proper use, the prevalence of sexually transmitted infections, the dangers of illegal abortions, and the medical care required for a safe childbearing experience. Valuable knowledge provided by the right people can have an astounding influence on changing the disposition of individuals, a step in itself to reducing maternal mortality rates.
In conclusion, despite the interventions of international organizations to reducing maternal mortality rates, countless women are still dying due to complications of pregnancy and/or childbirth each year. If we are to meet the goals set out the by the MDGs and the SDGs, it is vital we amplify our efforts to further the progress already catalyzed by them. With proper measurements of maternal deaths and causes in different regions around the world, the various challenges each region faces in reducing maternal mortality, and the possible interventions that can be implemented, maternal mortality ratios can be further reduced, making childbearing safe and giving women the care they deserve as they play one of the most vital roles in society.