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Global Maternal Health in Crisis, Despite Progress

Today, May 13, is Mother's Day in the United States. It's a special time to appreciate all that mothers do for our families and communities, and to be grateful for the health and well-being of those who gave us life. But in many parts of the world, adequate health care for mothers during their pregnancy and childbirth remains an elusive goal.

No matter where a woman lives, becoming a mother poses a significant health risk. According to the Safe Motherhood Interagency Group, a coalition of United Nations and international health organizations, 15 percent of all pregnancies worldwide present medical complications that are serious enough to require professional health care at a modern clinic or a hospital.

According to Ann Starrs of Family Care International, or FCI, a New York based non-profit group that promotes maternal health, that is where women in the developing countries are at a huge disadvantage. "In Africa for example, we have a situation where that region accounts for about 13 percent of the global population,; it accounts for about 25 percent of the world's maternal deaths, and it has about 3 percent of the world's health workers."

Starrs cites three main reasons why women in the developing world lack the health care resources they need. "First, a lot of the health workers have HIV AIDS, and so many of them are dying themselves. Second, many of the health workers, particularly the ones with more advanced skills -- midwives, doctors and nurses -- are enticed off to England and other foreign countries which offer them much higher pay than what they can get at home."

A third reason, according to Starrs, is that "countries are not investing enough in training these kinds of personnel, so there are not enough being produced for national needs even to begin with."

Cultural barriers also often prevent women from getting the health care they require. "In some settings, women are not allowed to make decisions without participation from their husbands," says FCI program coordinator Elizabeth Westley. "So in a situation where a husband may be traveling, a woman would not be able to visit a health care setting until a husband returns."

In some places, mothers in distress are actively prevented by their family members from seeking clinical help. In some parts of Africa, for example, says Westley, "there is a strong belief that if a woman has obstructed labor during childbirth, then that that's a 'sign' that she was unfaithful to her husband and the family won't take her to a health facility until she has 'confessed' the name of the man she 'cheated with.'"

"That kind of traditional value or belief is obviously a major obstacle to women accessing the services they desperately need at a time like that," adds Ann Starr.

In some cultures, mothers resist going to hospitals to give birth because home births remain a powerful traditional norm. In South Asia, health facilities are generally better than in Africa, but fewer women per capita use the medically trained attendants such as doctors and nurses that are available.

Cultural mores can also play a significant role in whether mothers will choose to give birth in a clinical setting. In many indigenous cultures of Latin America, for example, mothers will not come to a hospital or clinical setting where traditional beliefs are not respectfully integrated into the care. Such practices might include the role of the mother-in-law during the birth process, how the placenta is treated and transported, and nurturing practices like backrubs and prayer.

One key to getting expectant mothers to clinics for care is to help local chiefs and other traditional authority figures understand the benefits of professional health care, and give it their blessing.

Ann Starrs says that one place where FCI has had excellent results with this strategy is in the West African nation of Burkina Faso. "And in just over two years," she says, "the percentage of women who deliver with skilled attendants, (and) who delivered in a health facility, went from 25 percent when we first started, to 56 percent. So it more than doubled!"

Infrastructure is also key to better maternal health. There must be usable roads, and enough fuel to transport mothers to the clinic, and clean, running water once they arrive. There must also be a dependable source of electricity for light and equipment. In many places, nighttime deliveries are lit by flashlight. FCI and other agencies are working to install solar power generators, especially in the sun-rich tropics, as one way to upgrade health facilities.

Next October in London, FCI will hold an international conference called "Women Deliver" where politicians, donors, researchers, health advocates, and educators from around the world will address these and other issues, and draft a plan of action.

Experts are guardedly optimistic. In some countries, such as Honduras, Malaysia and Sri Lanka, maternal mortality rates have dropped by 50 to 75 percent over recent decades. Those are results that conference organizers intend eventually to match, or exceed, in every country in the world.