Stopping The Invisible Epidemic Of Maternal Deaths

The needs are wide-ranging - from training skilled birth attendants who can help a woman give birth safely, to the very basic issue of recording the cause of a woman's death. WHO estimates that maternal deaths are under-reported by as much as 50% because deaths are not classified correctly, or more often, not counted at all. In 62 countries of the world, there are no maternal mortality data whatsoever.

"If dead women are not even counted, then it seems they do not count. We have an invisible epidemic," said Joy Phumaphi, World Health Organization's Assistant Director-General on Family and Community Health, at a gathering of health ministers, maternal health specialists, African Parliamentarians, leaders of non-governmental organizations and donor agencies today in Nairobi.

"Pregnancy is a normal, life-affirming state. Women should not die giving birth. Their deaths are preventable, even in the poorest countries. But it takes local knowledge, strength and partnership to ensure women's lives are saved."

While the main causes of maternal deaths are haemorrhage, infection, hypertensive disorders, obstructed labour and unsafe abortion, the fundamental reasons for the continuing crisis are unavailable, inaccessible, or poor quality care. The effects are tragically amplified, as some one million children are left motherless each year. These children are 10 times more likely to die in childhood than children whose mothers have not died.

Maternal mortality shows a stark divide between rich and poor countries. In some developing regions, a woman has a one in 16 chance of dying in pregnancy and childbirth. This compares with a one in 2 800 risk for a woman from a developed region. Sub-saharan Africa and central south Asia in particular suffer high rates of maternal death. The risk of dying in pregnancy in the world's poorest countries is over a hundred times higher than in the richest ones.

"Countries around the world have pledged to achieve the Millennium Development Goals, which include reducing maternal mortality by three quarters by 2015. One key task of the global health community is to close the gap in services for women in rich areas, and those in poor ones." said Joy Phumaphi.

"It is the duty of all governments to lead the fight against maternal and neonatal mortality," said First Lady of Kenya, Lucy Kibaki, who jointly chaired the Nairobi meeting. Praising the solidarity shown by the African parliamentarians present at the launch, Lady Lucy Kibaki added, "Only by joining forces can we achieve our common goals." As part of its support, WHO is beginning world-wide training for health staff today. A new manual for health planners and providers, Beyond the numbers - Reviewing maternal deaths and complications to make pregnancy safer is also available. The manual delves into the question of why women die from complications related to childbirth, and spells out how to avoid them by using effective and affordable methods which can be implemented in even the poorest settings. Beyond the numbers is the new focus for WHO regional and country offices and partners from more than 20 regional and international agencies, including UNFPA, UNICEF and the World Bank. This programme includes the training of health planners and providers in high-risk countries and regions in the use of five methods to gather information upon which to base actions: verbal autopsies, reviewing deaths in the community, health facility-based reviews, confidential inquiries, near-miss case reviews and clinical audit.

The implementation of this initiative is urgent, but requires more resources. US$ 10 million are needed to train decision-makers, national health planners and medical service providers. This will take place in 20 high-priority countries. Funds will also be used to measure progress.

"Each time, such a gathering reminds us vividly of the loss of lives of those we cared for and our beloved ones. It is time for all of us to turn technical knowledge into action to save the lives of the women who give life," said Dr. Luc de Bernis, one of the authors of Beyond the numbers from WHO.