Saving Mothers’ Lives

Amanda PuckettMuch literature has celebrated the recent World Health Organization report that maternal mortality declined by a third in the past decade. Though this downward trend is remarkable, the global public health community is concerned that the declaration will shift attention away from sustaining and increasing efforts to address maternal deaths throughout the world. Also important is decreasing maternal morbidity, which creates huge costs in terms of human suffering, health care expenditures, and lost productivity.

Health systems strengthening reduces maternal mortality
The headline The Top Three Things We’re Not Doing to Save Mother’s Lives recently caught our attention. CapacityPlus’s result areas—global leadership, policy and planning, education and training, workforce effectiveness, and evaluation and knowledge-sharing—are key pieces of the health systems strengthening puzzle needed to improve health outcomes for men, women, and children. Addressing the global health worker shortage, which is most critical in countries with higher maternal mortality rates, will strengthen health systems and improve more than just maternal outcomes.

Kate TulenkoThe article claims that health systems strengthening isn’t “sexy”, which explains why it doesn’t get as much donor funding as other initiatives that target specific diseases. We beg to differ. There is no more attractive way to invest time and resources than ensuring a system functions at all levels so that health services are delivered at a high quality and effectively to populations. Strong systems enable the rest of those “sexy” services like antiretrovirals and immunizations to function at capacity.

Access to contraception and postabortion care
Birth spacing and unmet need for family planning are major concerns for women in many parts of the developing world, but barriers too often prevent women from obtaining access to contraception. These obstacles include logistics, money, access to a provider, and gender norms. Today, more than 200 million women around the world have an unmet desire to control their fertility, and this should not be ignored.

It is estimated that globally 20 million unsafe abortions occur each year, and account for 13% of maternal deaths as well as long-term morbidity for many women who suffer from such consequences as chronic pain, pelvic inflammatory disease, tubal occlusion, and secondary infertility. Improving access to both preventive contraception and emergency contraception has the double benefit of dramatically decreasing the number of abortions performed each year. In addition it is important to continue to expand and scale up primary-level postabortion care services that include family planning counseling and methods.

Back to the health system
What is striking about the elements needed to save mothers’ lives is that they require a strong health system. Access to contraception and postabortion care in countries where abortions are currently illegal demands a properly functioning health system. How can access to contraception be improved without a qualified health workforce and fully stocked and operational facilities?

Let’s focus this list even further. We suggest that the one thing we need to doing more of to save mothers’ lives is health systems strengthening.

Photos: Courtesy Amanda Puckett and Kate Tulenko