Safe Motherhood: A Matter of Human Rights & Social Justice
Dr. Rita Luthra
Women's Health & Education Center (WHEC)
United States of America
Safe-Motherhood means ensuring that all women receive the care they need to be safe and healthy throughout pregnancy and childbirth. For the last several decades women's issues were compressed in the words "half of humanity". Still the other half of humanity has not yet become fully conscious of what is the basic condition of life of women. Women and children represent about 75% of the world's population. Some of the implications of "the population problem" for the quality of human life are obvious. The ideal solution to the problem would combine a slowdown in the rate of world population growth (or zero growth) with a redistribution of population in relation to resources.
The purpose of this document is to understand women's reproductive rights and how to balance these with the imperative that communities and societies will then be more likely to make reproductive choices. It will serve not only in their own interests, but society's as well. Cross-culturally, most women even though are educationally and instrumentally "empowered" -- are not really in-charge of their own fertility; their societies and cultures are. The good news is that -- social change is constant. The role of OB/GYN societies in training is most helpful. Providing education in women's health, maternity care and family planning can ensure that these opportunities are fully used in future.
Problem at a Glance:
- Of all the health statistics monitored by the World Health Organization, maternal mortality has the largest discrepancy between developed and developing countries.
- Everyday at least 1,600 women die from the complications of pregnancy and childbirth. That is, 585,000 women, at a minimum dying each year.
- Complications of pregnancy & childbirth are the leading cause of death & disability for women in developing countries aged 15-49.
- 50 MILLION women experience pregnancy-related complications every year, many of which lead to long-term illness or disability.
- There are estimated 200 million pregnancies around the world each year. One third of these, or 75 million pregnancies are UNWANTED.
- Every pregnancy faces risks: every time a woman is pregnant -- at least 40% of all pregnant women will experience some type of complications during their pregnancies and for about 15%, this complication will be potentially life threatening.
- Each year, approximately 20 million unsafe abortions are performed worldwide. They result in nearly 80,000 maternal deaths and hundreds of thousands of disabilities. In some countries, unsafe abortion is the most common cause of maternal death. It is also one of the most easily preventable and treatable.
- If all women who said they wanted no more children were actually able to stop childbearing, the number of births would be reduced by an average of 35% (4.4 million) in Latin America, 33% (24.4 million) in Asia and 17% (4 million) in Africa. Maternal mortality would fall by even higher proportions since the births that would be averted, would tend to be the high-parity/high-risk births.
- Birth intervals of less than 36 months significantly increase the risk of complications and death.
Source: World Health Organization
What is Safe Motherhood?
Although the aims of antenatal care are the same all over the world, the actual practice varies from one region to another. The majority of maternal deaths could be prevented if improvements in women's status coupled with a substantial extension of primary healthcare facilities, including family planning and referral services were made possible. Involvement of obstetricians and gynecologists, both as individuals and through their national OB/GYN societies in advocacy and technical support is needed for safe motherhood and women's health. The aim of safe motherhood is not just to reduce the inexcusable toll of maternal deaths and disabilities. It is to ensure that the outcome of every pregnancy is a healthy mother and healthy newborn. From the moment of birth, all newborn babies, whether sick or well, need special attention and care to survive and be healthy. Yet in many countries, the odds are stacked against both women and their newborns.
The essential elements of Safe-Motherhood are:
- Community education on Safe Motherhood;
- Prenatal care and Counseling including the promotion of maternal nutrition;
- SKILLED assistance during childbirth;
- Care for obstetric complications, including emergencies;
- Post Partum Care;
- Management of abortion complications, post-abortion care and where abortion is not against the law, safe services for termination of pregnancy;
- Family Planning Counseling, information and services;
- Reproductive health education and services for adolescents.
How can empowering women make motherhood Safer?
Anyone who has cared for a woman knows that if physically ill herself, the mother (and father) will be anxious, stressed, depressed and sometimes inconsolable. Those who understand the true impact of pregnancy and birth on the hearts and minds, lives and well-being of women fully understand this vital connection. The partnership is -- advocating for increased political will and progress towards the Millennium Development Goals for maternal and child health. Strengthening commitment to improving access to care and quality of care is a priority of the partnership. Fostering partnerships for communication and coordination can strengthen the Safe-Motherhood programs. The challenges in Africa are many, including high fertility rates, low contraceptive use, early onset of sexual activity and early marriage -- all of which contribute to half of the 585,000 maternal deaths annually worldwide. These deaths take place in a continent that constitutes only 13% of the world population and only 23.5% of births. Empowering individuals, families and communities is the way forward.
The reality of women's lives, especially in developing countries is such that they neglect their own health. Opportunities to improve their health conditions are indeed limited. The reasons for this are numerous and include among others, the burdens of caring for home, children, family and also the responsibility of food production and preparation. Moreover, women's health also suffers from the low status they are accorded; the lack of an organization and the power to exert any political pressure.
Empowering enables women to:
- Speak out about their health needs and concerns;
- Seek services with confidence and without delay;
- Demand accountability from service providers, and from governments for their policies;
- Participate more fully in social and economic development.
What is the role of national OB/GYN societies?
Reducing maternal and newborn mortality is increasingly important in light of the United Nation's Millennium Development Goals (MDGs).
The global Safe Motherhood initiative began in 1987 with the aim of bringing down high numbers of mothers dying in the developing world. Since then, much has been learned about saving women's lives during pregnancy and childbirth, and about the close links between maternal and newborn health. One of the most helpful actions that OB/GYN societies could take in this area would be to identify, in collaboration with women's organizations, the Ministry of Health and other relevant partners for providing education in women's health. In light of the national situation on maternal and perinatal health, the national OB/GYN society should define the content of a number of simple messages, which embody those aspects about maternal health and healthcare. Information on self-care and community in general, is essential.
One example in present medical curricula is the relative failure to help healthcare providers understand the need to take into account the totality of women's health throughout the life cycle and to provide more humane and understanding level of care. Discussion of and concern for women's perspectives about their health needs should be a routine part of the training of health professionals. Every national society has a duty to be involved in monitoring the quality of maternal healthcare. The national society should encourage, facilitate, stimulate research related to the accomplishment of goals of the Safe Motherhood Initiative, and particularly in areas where maternal mortality is high.
Thinking globally and advocating nationally -- a national movement can be established
Some specific suggestions are:
- National societies should contribute to continued education, and not only of their own professions and specialties but have all providers of maternal health and family planning care, and especially those at primary and first referral level.
- Efforts to improve curricula would probably be more successful if national societies support training by objective. They might then take the stated objectives of their country in reduction of maternal and perinatal mortality, and increase family planning services availability.
- Women's health in general and in cooperation with their partners, try to spell out clearly the type of training that is essential for the attainment of these objectives from the obstetricians to the traditional birth attendants or midwives.
- Operational research (sometimes called health system or "action-research") is a very important area in which the national OB/GYN society can play a major role.
- Safe Motherhood operational research consists essentially of the evaluation of improvements and innovations in maternal healthcare, especially the preventive aspects.
- The evaluation of educational campaigns
Maternal health is a multifaceted problem with social, psychological and cultural roots. There is no simple or single solution to the problem; rather women's healthcare must be addressed at multiple levels and in multiple sectors of society to develop effective projects and programs. We have, for several decades, had the knowledge and means to remove much of the risk and uncertainty associated with childbirth. With the growing motivation and political will the need for better information has become more acute. Women have right to Safe-Motherhood.
Aim to ensure equal access to affordable and quality healthcare. Health-for-all. Building the evidence base, mainly community-based research that is affordable and which has immediate implications for programs and local partners should be encouraged. The community has an important part to play, particularly in addressing delays in access to emergency care and access to family planning services.
All human beings are born free and equal in dignity and rights. We encourage you to read The Report of the UN Secretary-General on Millennium +5 entitled "In Larger Freedom: Towards Security, Development and Human Rights for All".
With thanks to UN-DPI, we hope you enjoy this publication and find it useful.
Dedicated to Women's and Children's Well-being and Health Care Worldwide