Sign Out: Maternal and newborn mortality: the silent tragedies

January 1, 2006

No issue is more central to global well-being than the health of mothers and their babies. Every individual, every family, every community at some point or another is intimately involved with pregnancy and the success of childbirth. And yet every day, 1,600 women and more than 10,000 newborns die due to complications that could have been prevented.

The challenges are the greatest in developing countries, where investment in health and other social sectors is dwindling. Health-care workers, infrastructure, equipment, and supplies are in short supply. Poor and underprivileged women continue to suffer the most.

Every year, there are more than 210 million pregnancies, of which nearly 87 million are either unwanted or unplanned. This is primarily due to a lack of access to good quality family planning services. At least 529,000 women and nearly 4 million newborn babies die each year and another 3.3 million are stillborn. Almost 90% of these deaths occur in sub-Saharan Africa and Asia.

About 40% of deaths in children under age 5 occur within the first 28 days of a baby's life. Newborn mortality is so intrinsically related to maternal health and well-being that unless countries address the issue of maternal health, newborn survival will fail to improve.

In many countries, particularly Africa, the prevalence of HIV/AIDS in pregnancy is alarmingly high, with more and more newborn babies testing positive for the disease. Many mothers die each year from HIV/AIDS, leaving thousands of children orphaned-and often infected with HIV.

In recent years, antenatal care services have proved successful in providing countries with a unique platform for prevention of HIV infection by keeping HIV-negative mothers free from infection, preventing transmission of HIV to their unborn babies, and by enrolling HIV-positive mothers for treatment.

Malaria in pregnancy is another challenge. Bed nets, malaria prophylaxis, and even basic treatments are not always available to pregnant women in most malaria-endemic countries. Without close collaboration between HIV/AIDS and malaria programs, the situation will not improve.

Since the inception of the Safe Motherhood Movement in 1987, we have learned a lot about what works to keep women safe during pregnancy and childbirth, and to save newborn lives. Addressing problems requires a well-functioning health system that encompasses all levels-from the community to referral facilities-and provides accessible, high-quality, and affordable care. Adequate supplies, skilled personnel, and an effective system for referral and transport are particularly important for managing obstetric emergencies.

The underlying medical causes of maternal deaths and disability are a range of social, economic, and cultural factors that contribute to women's health and nutritional problems before, during, and after pregnancy, and are directly linked with women's low utilization of available health services.

Many developing countries, including Botswana, Costa Rica, Cuba, Malaysia, Sri Lanka, and Thailand, have shown that it is possible to reduce the number of women and newborns who die in childbirth.

To achieve target goals in reducing maternal and newborn mortality, countries must demonstrate strong political will, sustainable investment, and a robust monitoring system. Countries cannot rely solely on external financial support. Maternal and newborn mortality reduction must be included in the national development plan and be the focus of increased budgetary allocations. Investment in maternal health is an investment in development and helps to alleviate poverty.

The continuing high incidence of maternal and newborn mortality is unacceptable, precisely because it is solvable.