A look at maternal care: Too little, too late for some; too much, too soon for others

A mom and her newborn baby at the Maternal & Child Health Training Institute in Dhaka, Bangladesh. (UN Photo/Kibae Park)

Despite overall improvements in maternal death rates, women receive poor-quality care in all countries, and the mortality-rate gap between rich and poor countries is growing.

A new series of papers published by The Lancet show that a combination of poor-quality health care and over-medicalization is harming women and children around the world.

The problem is twofold: For women in poor countries, care is often too little, too late. For women in wealthy countries, it is an issue of too much, too soon. The two converge as more countries improve health systems.

The gap in the death rates between in the richest and poorest countries doubled between 1990 and 2013. Within every country, the quality of care for the poorest women lags behind that of the richest.

“In all countries, the burden of maternal mortality falls disproportionately on the most vulnerable groups of women. This reality presents a challenge to the rapid catch-up required to achieve the underlying aim of the Sustainable Development Goals – ‘to leave no one behind,'” series author Wendy Graham said in a statement.

Closing the gap between the rich and poor is crucial when 240 million women become pregnant and deliver 140 million babies each year.

Roughly 53 million women give birth without a skilled birth attendant. Most are concentrated in low-income countries, and it is often due to the lack of access to quality health centers and/or skilled staff. Other obstacles like bad roads, no electricity and poverty contribute to the problem as well. For these women, care options are extremely limited and by the time they access quality care it is often in an emergency – too little, too late.

Wealthy countries, and increasingly all parts of the world, have a different challenge. Health-care systems are in much better shape, but that doesn’t guarantee optimal care. Some countries report high caesarean-section rates and short hospital stays.

In Latin America and the Caribbean, the caesarean section rate is 40.5 percent – a rate the World Health Organization said should be closer to 10 percent to 15 percent. At that rate, an unnecessarily high number of women are at risk of complications related to surgery. Overuse of a life-saving procedure puts women at risk for serious complications – too much, too soon.

When it adopted the Sustainable Development Goals last year, the international community set out to reduce maternal deaths to fewer than 70 per 100,000 live births by 2030. That would require a 68 percent reduction from the current rate of 216 deaths per 100,000 live births. The papers endorse ideas like universal health coverage, stronger health systems and funding to reach that goal.

“The dual streams of poor-quality or inaccessible care coexist everywhere – a universality that spans countries of low, middle and high income, including fragile and conflict-affected nations; and those considered economically and politically stable,” according to the paper. “Every woman, everywhere, has a right to access quality maternity services, and the benefits of such access extend to the fetus, newborn babies, children, and adolescents.”

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Tom Murphy

Tom Murphy is a New Hampshire-based reporter for Humanosphere. Before joining Humanosphere, Tom founded and edited the aid blog A View From the Cave. His work has appeared in Foreign Policy, the Huffington Post, the Guardian, GlobalPost and Christian Science Monitor. He tweets at @viewfromthecave. Contact him at tmurphy[at]humanosphere.org.