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The “Three Delays” at the Root of Maternal Mortality

Maternal_Mortality
The World Health Organization (WHO) estimates 303,000 women will die of maternal causes by the end of 2015. While this figure has been reduced by approximately 44 percent in the past 25 years, improvements to maternal mortality rates still need to be made. Almost 99 percent of maternal deaths occur in developing regions, two-thirds of which are concentrated in sub-Saharan Africa.

In 1994, Sereen Thaddeus of the United States Agency for International Development (USAID) and Deborah Maine, Professor Emerita at the Columbia University Mailman School of Public Health, linked causes of maternal mortality to “three delays:” delay in seeking care, delay in arrival at a health facility, and delay in the provision of adequate care.

Today, these three delays still make up a framework that helps in understanding what causes maternal deaths.

1. Delay in Seeking Care

Around 28 percent of maternal deaths stem from pre-existing conditions like anemia and malaria, according to WHO. Women, however, may put off seeking prepartum care because of the inadequacy of available health facilities.

The question of agency plays another role in this delay. According to Kingsley Ighobor, in some countries such as Mali, Burkina Faso and Nigeria, many women do not make the decisions over their health. This responsibility is instead left to spouses or other relatives.

2. Delay in Arrival at a Health Facility

Those living in rural areas face the major obstacle of distance from healthcare facilities. In developing nations, Thaddeus and Maine pointed out how weak infrastructure often means poor roads and slow transportation methods which can delay a woman’s arrival at a health facility.

Socioeconomic divisions within countries often mean unequal access to health facilities. WHO reports “delivery care… is strongly associated with their income, whether they live in a rural or urban area, and their level of education”.

3. Delay in the Provision of Adequate Care

Postpartum hemorrhage accounts for 27 percent of maternal deaths while obstructed labor constitutes eight percent.

Especially in developing nations, a shortage of staff, insufficient training, little to no antibiotic availability and more means health facilities are often ill-equipped to respond to a mother’s needs during and after her pregnancy.

Inadequate sanitation can also be detrimental to mothers. Maternal deaths as a result of infection rank at 15 percent.

Solutions moving forward

Goal Three, Target 3.1 of the 2015 Sustainable Development Goals seeks to “reduce the global maternal mortality rate to less than 70 per 100,000 live births by 2030.”

Achieving this goal may call for tackling the three delays that play a central role in the causes of maternal mortality.

“One of the easiest ways to continue to reduce the rate of maternal mortalities is to improve access to reproductive health”, Dana Dovey of Medical Daily said.

Educating women and relatives on reproductive health along with strengthening the infrastructure of health facilities is necessary to ensure mothers have the help they need for safe pregnancies.

– Jocelyn Lim

Sources: Medical Daily, Kingsley Ighobor, Nawal M. Nour, Sereen Thaddeus and Deborah Maine, United Nations, World Health Organization (WHO), WHO report on health from MDGs to SGDs, WHO: Trends in maternal mortality, 1990-2015
Picture: Google Images

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Maternal Mortality in Zambia

Maternal_Mortality
Zambia is a landlocked country in southern Africa with a population of about 15 million. It borders Angola and the Democratic Republic of The Congo. One of the main health problems that Zambia faces is maternal mortality. However, in recent years the maternal mortality rate (MMR) in Zambia has declined.

In 1996, the MMR in Zambia was 649 per 100,000 live births. Although this number rose throughout the years, to a total of 729 per 100,000 births in 2002, by 2011, the MMR in Zambia had fallen to 591 per 100,000.

Hemorrhaging, or extensive bleeding, is one of the main causes of maternal mortality. Many women who give birth at home do not have the blood transfusions available to help them recover from the loss of blood, and some hospitals also do not have enough blood available to provide those transfusions. According to the United Nations Population Fund (NFPA), hemorrhaging accounts for 34 percent of maternal deaths.

The Population Reference Bureau reports that another main cause of maternal mortality in Zambia is obstructed labor, which is when the infant is not able to exit its mother due to its position or the size of its head. Obstructed labor can be solved by giving birth via C-section, but many people give birth at home and some hospital attendants are not able to perform the C-section needed for a safe delivery. 8 percent of the maternal deaths in Zambia are due to obstructed labor.

Infections due to unsanitary conditions during delivery also account for some of the maternal deaths which occur in Zambia. 13 percent of mothers die because of poor hygienic conditions during their delivery. Other causes of maternal mortality include complications from unsafe abortions and underlying causes such as malaria, anemia, HIV or cardiovascular disease, diseases that are aggravated during delivery.

Another problem is that many women are not able to go to a hospital and receive the help that they need. Only 47 percent of births in Zambia are attended by a skilled health worker. Urban women are more likely to have access to a hospital at the time of birthing. Women also choose to not go to a hospital because of traditional beliefs and customs, which promote home births and the use of traditional healing — such as the drinking of certain herbs that are supposed to help women deliver quickly. These herbs can cause vomiting and diarrhea and sometimes complicate the delivery.

Groups such as UNICEF and Saving Mothers; Giving Life (SMGL) are working to help lower the number of maternal deaths in Zambia. Saving Mothers; Giving Life is a group that works with the Zambian government and has a six-step plan they use to helping decrease the MMR. Firstly, they equip facilitates so that they are prepared to help women with complications receive care within two hours. They also work to increase the availability of drugs and equipment, train and mentor health professionals, promote better transportation to health facilities, improve data collection and help mobilize communities to increase demand for hospital births. Since 2011, they have been working in four districts in Zambia and have decreased the MMR in those districts by 35 percent.

UNICEF, according to their website, funds programs and interventions aimed at improving care for mothers and children. The government of the Republic of Zambia is also playing a large part in improving the MMR, as they have abolished user fees for maternal and child health services in order to grant larger access to such services.

All of these efforts have paid off, as shown by the dramatic success of Saving Mothers; Giving Life. However, in order to help continue to reduce MMR, programs such as those implemented by SMGL should be established throughout the entire country.

– Ashrita Rau

Sources: UNICEF, Saving Mothers, PRB, The CIA World Factbook
Photo: Flickr