In the last quarter-century, maternal deaths around the world have almost halved. But there is much work still to do. Some 300,000 women die every year during childbirth or pregnancy – most of them in developing countries, and from preventable causes.
“Women are not dying because of diseases we cannot treat. They are dying because their societies consider they are not worth investing in,” said a participant at the ‘Together for the Next Generation’ conference in Brussels.
The conference brought together medical professionals, researchers and policy-makers to plan how research can support the advancement of the Sustainable Development Goals, which set out the ambitions of the development community until 2030, and in particular accelerate the maternal and newborn health gains achieved up till 2015.
As well as outlining immediate actions which can reduce maternal deaths, the conference highlighted the need for more nuanced data collection to inform planning and programme development. The benefits of stronger links between researchers and policy-makers were emphasised, with particular focus on how results and innovations can be used to achieve the 2030 goals connected to maternal and neonatal health.
Towards Safe Birth
“Investment number one has to be in family planning and sexual and reproductive health and rights,” said Marleen Temmerman, professor at the Faculty of Medicine, Ghent University, and at the Aga Khan Development Network, Kenya.
Deaths from unsafe abortions make up 13% of maternal deaths. As well as saving lives, access to contraception would improve gender equity and bring socioeconomic benefits. “When girls and women can choose when to have children, how many and who with, they begin to have equality,” said Temmerman. “They can complete their education and participate in the labour market.”
“Investment number two must be in quality of care,” said Temmerman. Although more women now deliver their babies in medical facilities than ever before, the quality of care is far from uniform.
“We have to invest in the moment of birth, which is a triple return on investment: you will save women’s lives, more children will survive, and you will prevent stillbirths. So even only implementing these two lines of work will make a major difference,” said Temmerman.
Impact of local context
Several speakers at the conference emphasized the importance of taking local context fully into account when designing and implementing programmes. Even when medical facilities are available and doctors and nurses trained, cultural traditions and social prejudice can stand between expectant mothers and healthcare, preventing pregnant women and their families from accessing or getting the most from available services.
Participants shared stories of denial of medical care during childbirth from varied country contexts. The particular reasoning or prejudice differs in each case, but the result is the same: a gap between the services on offer, the data gathered by health facilities, and the reality experienced by patients.
An example from India provides a stark illustration:
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In some Hindu communities, pregnant women from the lowest rungs of the caste system are particularly vulnerable to neglect and even abuse during childbirth.
Discrimination on the basis of caste has been illegal in India for over six decades. “But the fact is, the [low-caste] mother is considered ‘untouchable’ during delivery,” said Dr Abhijit Das, director at the Centre for Health and Social Justice in New Delhi. “There is fear of pollution,” the idea that low-caste citizens are impure and must use different water sources, different entrances to buildings and even different utensils in restaurants. “It means that in many peripheral hospitals, it is not the nurse or trained provider who will deliver the baby, but the underclass, untrained attendant,” said Das. Details like this weaken the impressive-sounding statistic that 80% of India’s babies are now delivered in medical institutions. Especially when the “institutions” in question may be little more than “four walls and a roof”, according to Das. |
There is an urgent need for more nuanced data to identify bottlenecks and challenges, and to guide efforts to ensure that the most vulnerable and poor populations receive the quality services they need, especially in remote locations.
“Research is becoming the handmaiden of development aid,” said Das. He called for the evaluation component of research to be isolated from the intervention element. “Intervention and monitoring frameworks are anxious to prove success. There has to be critical enquiry, evidence about what is not working, and what marginalised communities think.”
New relationship between research and policy
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"The research community has a crucial role to play as part of the partnership-based approach. This will help to make informed decisions, ensuring available scarce resources are efficiently and effectively used to reach those in need. This will not only require research on technology assessment, but also on health care delivery systems." - Commissioner Neven Mimica |
“One of the major obstacles is just not talking to each other,” said Nkandu Luo, Minister of Gender and Child Development in Zambia. As a microbiologist and doctor of immunology before entering parliament, Luo offered insight into the lack of interaction between the research and policy arenas.
“The researchers are on their own researching and publishing, end of story. The implementers are also sitting there wondering where they will find the evidence for them to implement. And the government is wondering where is the evidence for them to make policies,” said Luo.
She revealed that even when the data exists on which to base policy, it does not reach the appropriate ministerial level. Ministers often send delegates to attend conferences where researchers present their findings, “and it goes no further.”
Luo suggested that forums be created at policy level, giving researchers direct access to ministers. “It should work everywhere. […] Policymakers [need] to start understanding the importance of making decisions based on evidence.”
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One avenue for collaboration is the European & Developing Countries Clinical Trials Partnership, which supports clinical product development tailored to pregnant and breast-feeding women, newborns and infants. The partnership currently comprises 14 European countries and 14 African countries, it will run until 2024. |
“We must continue speaking to each other,” said Luo. “Sometimes it’s frustrating, but if we continue the path of frustration, we will lose many more women.”
The wide-spread benefits of investing in maternal and newborn health research are clear. It is an essential ingredient in the wider development goals to advance gender equality, improve child nutrition and welfare, and break the cycle of poverty.
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The EU contributed €690 million from 2007-13 to over 300 research projects which focused on maternal, newborn and child health. |
“Health is the best barometer of social justice,” said David Chiriboga, former Minister of Public Health for Ecuador. “We can see health as the outcome of the living conditions in a community, and how fair they are.”
The verdict in many countries is not positive. “A tremendous amount has been accomplished through the western development model,” said Chiriboga. “But progress has been slow in some areas, and many things have not changed. […] Most interventions through development aid have been fragmented and served to mitigate [suffering] rather than to transform societies aiming at health equity and social justice. The resources required for such a transformation are significantly higher than the official foreign aid. It is time to rethink the need for a more effective and realistic global wealth redistribution system.”
Tackling maternal health needs investment in areas beyond medical research and developing public health facilities. Even when well-equipped hospitals exist, expectant mothers can be held back by something as basic as poor roads. The role of transport infrastructure in health is just one example of the importance of linking up different projects and budgets within development.
Further Reading
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Birth Day Prize 2017: an award for a solution to reduce maternal and/or newborn morbidity and mortality during facility-based deliveries |
Health Via Health Roads (Voices & Views)
Using Mobile Networks to Bring Medical Services to Remote Areas (Voices & Views)
‘Health Equity – the Key for Transformational Change’
This collaborative piece was drafted with input from Marianna Lipponen from DEVCO and Barbara Kerstiens from DG Research, with support from the capacity4dev.eu Coordination Team.
Image Credit: DFID via Creative Commons
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