She had begun to miscarry the day prior, but her family did not realize something was wrong until much later. She arrived to the clinic by motorcycle at dawn but could not get an appointment, so she waited five more hours until getting emergency care. By that time her garments were soaked in sweat and blood. She grasped my hand for over two hours as Dr. Jim performed an emergency curettage. Later I cleared the aftermath from the floor and table in a daze, horrified at the suffering this women had endured because she had not gotten care soon enough. While this young Haitian women survived, countless women around the world die each day from similar complications. Currently the majority of maternal deaths occur from direct causes relating to labor[i] with women in poor nations and rural areas suffering a disproportionate maternal burden.
The factors contributing to maternal mortality are structural and cultural. The direct causes of maternal mortality are hemorrhage, infection, eclampsia, and obstructed labor[ii]. Deaths from direct causes are preventable with the proper medical care and the risks of occurrence are reduced with prenatal care. With one third of all births occurring in the absence of a skilled birth attendant[iii], many families do not understand the process of pregnancy and therefore fail to recognize when a complication occurs. The gap between the time when treatment is needed and when it is sought (if it is sought at all) is often too great. Even when a family has decided to seek care, those living in areas with low health worker density do not have means of transportation or time to reach the nearest facility. Additionally, many people cannot afford to pay for treatment. Furthermore, the treatment is often inadequate or untimely due to limited resources or poorly trained health workers.
Who do these barriers inflict the most suffering upon? Women living in rural area and women living in the poorest countries in the world. In fact, in 2005 only eleven countries accounted for 65% of maternal deaths![iv] Sociocultural factors that contribute to direct causes of maternal mortality are entry into early marriages, short intervals between pregnancies, female genital mutilation, and gender barriers to health care. Gender-based cultural barriers in Afghanistan contribute to the country’s staggering maternal mortality rate of 1,800 maternal deaths per 100,000 births[v]. In Afghanistan women are not allowed to travel without a male companion and women are discouraged to seek treatment from male physicians[vi]. Caste systems also bar women from prenatal care. Women living in rural areas have less access to trained medical professionals and facilities, are less likely to identify medical crisis, are less able to afford treatment, and cannot easily reach clinics. These barriers inflict the most damage upon the world’s impoverished and oppressed women. A good place to start addressing the problem is to train female community birth attendants in rural areas, but in order to meet the MDGs evaluations of cultural practices and education programs are needed, which will be more difficult.
The “fatal intersection of inequities[vii],” victimizes mothers as well as their families. The mortality rates of surviving children and of other community members increases with the loss of a mother, with maternal deaths contributing to stillbirths and countless deaths of newborns[viii]. Rampant maternal mortality rates stem back to health worker density shortages. It demands increased access to education and care for women and for accessible family planning resources. Gender discriminatory practices like FGM, early marriage, and restricted access to care must be addressed. Women have irreplaceable reproductive and productive roles in their community. It is an injustice for women of limited resources to suffer so disproportionately from this natural process of human life.
[i] Skolnik, R. (2008). Essentials of global health. Sudbury, MA: Jones and Bartlett Publishers.
[ii] Skolnik, R. (2008). Essentials of global health. Sudbury, MA: Jones and Bartlett Publishers.
[iii] World Health Organization, Initials. (2009, November 27). Skilled birth attendants. Retrieved from http://www.who.int/making_pregnancy_safer/topics/skilled_birth/en/index.html
[iv] House of Commons International Development Committee. (2008) Maternal Health: Fifth Report of Session 2007-2008, Vol. 1. (Incorporating HV 1075-i) London: Stationary Office Limited. Retrieved from http://www.publications.parliament.uk/pa/cm200708/cmselect/cmintdev/66/66i.pdf.
[v] World Health Organization, Initials. (2009, January 13). Midwife training programme aims to reduce maternal mortality in Afghanistan. Retrieved from http://www.unicef.org/infobycountry/afghanistan_47120.html
[vi] World Health Organization, Initials. (2007, October 12). Maternal mortality ratio falling too slowly to meet goal. Retrieved from http://www.who.int/mediacentre/news/releases/2007/pr56/en/index.html
[vii] Boama, V., & Arulkumaran, S. (2009). Safer childbirth: a rights-based approach. International Journal of Gynecology and Obstetrics, 106(2), Retrieved from http://www.ijgo.org/article/PIIS002072920900143X/fulltext
[viii] Boama, V., & Arulkumaran, S. (2009). Safer childbirth: a rights-based approach. International Journal of Gynecology and Obstetrics, 106(2), Retrieved from http://www.ijgo.org/article/PIIS002072920900143X/fulltext