Maternal Mortality & Sustainable Development

Maternal Mortality & Sustainable Development

Out of the 17 SDGs, SDG 3 ensures healthy lives and encourages well-being for people of all ages. Reducing the maternal mortality ratio is one of the major targets under this goal as a higher value of this parameter is a major obstacle in achieving sustainable development. Hence, nations have joined hands to speed up the decline of maternal mortality by 2030.

 What is the Maternal Mortality Ratio (MMR)?

In simple words, the maternal mortality ratio is a measure of the deaths of women from pregnancy-related problems or during childbirth. It is measured as the number of maternal deaths per 100,000 live births.
The targets

  1. Global target: MMR is covered under SDG 3 and the global target is to bring it down to less than 70 per 100,000 live births by 2030. By the same year, global access to sexual and reproductive healthcare services also needs to be achieved.
  2. National target: All countries, by 2030, should lessen their respective MMRs minimum by two-thirds of their 2010 values. Also, by 2030, the MMR in any country should not exceed 140 maternal deaths per 100,000 live births.

An overview of worldwide MMR

  • As per WHO & UNICEF Currently, the global maternal mortality rate stands at 211 per 10,000 live births. The decrease in MMR has been about three times, i.e. by 38% between 2000 and 2017.
  • Not only on the global front but the region-wise progress of MMR has also been tracked. In the time period between 2000 and 2017, South Asia made the highest progress of 59% in reducing the MMR. Sub-Saharan Africa has also shown a significant reduction of 39% in this regard in the same period.
  • However, around 810 women still die due to pregnancy and childbirth-related issues. And sadly most of the deaths are from preventable reasons like infections.
  • There is a huge gap between the maternal death rates of low income countries and high income countries. While the MMR in low income countries in 2017 is 462 per 100, 000 live births, it is as low as 11 per 100,000 live births in high income countries.
  • As per the Fragile States Index of 2017, 15 countries were regarded as fragile states and were assigned to be “very high alert” or “high alert” status. These nations are South Sudan, Somalia, the Central African Republic, Yemen, Syria, Sudan, the Democratic Republic of the Congo, Chad, Afghanistan, Iraq, Haiti, Guinea, Zimbabwe, Nigeria, and Ethiopia).
  • The COVID-19 pandemic has disrupted the health infrastructure and has put a negative impact on the global MMR in the last two years.

Methodology

  1. The visualization of the country wise MMR is based on the Our World in Data.
  2. The visualization of the regional MMR is based on the Statistical Annex of Sustainable Development Report 2021 by UN
  3. The visualization of the COVID 19 Mortality (CMR) is based on Our World in Data from 24 Feb, 2021 to 27 Nov, 2021 daily average deaths caused due to COVID.
  4. The visualization in the Table is based on two parameters COVID 19 Mortality & MMR.

From the table, it can be observed that regions like Sub-Saharan Africa, least developed countries, landlocked developing countries, southern Asia have the highest MMRs and have been assigned the lowest points. Also, these are some of the regions lagging behind in sustainable development. On the contrary, the developed regions of the world like Europe, North America, Australia, and New Zealand have the lowest MMRs and are thus assigned the highest weightage values out of 100 points.  The table also shows the Covid Mortality Rate (CMR) for each of the regions so that the two data (CMR and MMR of every region) can be compared. To denote high MMRs and CMRs, the red colour has been used. For moderate and low MMRs, CMRs, yellow and green colours have been used respectively.

Reasons behind high MMR in the concerned regions

 As we can see from the table, maternal deaths are extremely high in some of the less developed regions like Sub-Saharan Africa, the least developed countries, and the landlocked developing countries. Some of the obvious reasons noted by UNICEF behind this include:

  • Inadequate maternal care facilities: During childbirth, professional care by doctors and nurses is mandatory. However, the lack of health care personnel in many of the less developed regions has made maternal and neonatal mortality very high in those regions. In some cases, especially for remote areas, even if the facilities are available, distance to them creates concern. Due to this, deaths from direct obstetric causes like hepatitis, anaemia, haemorrhage, ruptured uterus, etc. are common.

Let’s take the example of a Sub-Saharan country, Mozambique. Here, health care personnel coverage was 4 healthcare workers per 10,000 people in 2000 which increased to only 5 healthcare workers per 10,000 people in 2000. On the contrary, in the same time period, the healthcare personnel coverage in Norway increased from 213 to 218. This clearly explains why Europe is among the regions with the lowest maternal mortality rate.

  • As per UNFPA Child marriage and adolescent pregnancy is one of the prominent factor: Girls of age 10-19 years face more complications during pregnancy as compared to women of higher reproductive age groups. Hence, maternal mortality has a higher chance of affecting adolescent girls, i.e., girls under the age of 15 years.

In less developed countries, child marriages are widely prevalent in spite of the presence of laws. In those countries, 40% and 12% of the girls are married off before reaching the age of 18 and 12 years respectively. Such victims of child marriage often become pregnant before their adolescence ends, thus increasing their risks of facing pregnancy or childbirth-related issues.

  • Illiteracy and a higher rate of pregnancy: In the less developed countries, literacy rates and childbirth-related awareness among the population are low. They don’t know much about the use of contraception or family planning. Consequently, pregnancies among such women occur in higher numbers, and their chances of dying also increase throughout their lifetime as compared to that of the more developed countries.
  • The gap between rich and poor: UNICEF observes that Worldwide progress has been made across the world in the direction of establishing maternal healthcare. Regions like South Asia have maternal mortality rates lesser than the world average. However, the reality is different for women from poor families. Research shows that in South Asia the rich women receive three times higher maternal healthcare than poor women. In the countries of central and western Africa, the gap between the rich and poor communities is more than double as far as access to maternal healthcare is concerned.
  • Illegal and unsafe abortions: Abortions are intentional termination of human pregnancies and are safe only if carried out by skilled professionals or by following the method recommended by the WHO. However, data reveal that 45% of abortions across the world are not safe and legal.  And 97% of it is occurring in developing nations. This results in health complications and subsequent deaths or morbidities. In India, 50% of maternal deaths result from illegal abortions.

Solution/targets introduced to reduce Maternal Mortality

The WHO and United Nations Population Fund (UNFPA) have jointly launched a global initiative, the Ending Preventable Maternal Mortality (EPMM) initiative, to bring an end to the occurrences of maternal mortality in order to show SDG 3’s progress and achieve the global target of 70 maternal deaths per 100,000 live births by 2030. Under this initiative, five targets have been introduced to be fulfilled by 2025 to meet the SDGs in the long run. These targets are as follows:

  1. 90% of pregnant women must have access to four or more antenatal care visits.
  2. 90% of childbirths must be handled by skilled health personnel.
  3. 80% of women who have just delivered a child must have proper access to postnatal healthcare facilities within two days of childbirth.
  4. 60% of the population must have access to emergency obstetric care within two hours of travel time.
  5. 65% of women must be in a position to make empowered decisions regarding sexual relations, contraceptive use, and their reproductive health.

These targets are for the entire world. Apart from these, certain targets have also been framed for definite countries or regions to bring higher equity.

Suggested Measures to Reduce the MMR

  1. Injecting oxytocins to prevent risks of bleeding and maintenance of hygiene after childbirth .
  2. Prevention of unwanted pregnancies, especially for adolescents.
  3. Widespread awareness regarding the use of contraception, safe abortion facilities, and post-abortion care.
  4. Improvements in the social, educational systems, and reduction of inequalities in accessing healthcare.
  5. Improvements in the healthcare system as well, mainly in terms of basic emergency obstetric care facilities like antibiotics, anticonvulsants, uterotonic drugs, assisted vaginal delivery, caesarean section, etc .

It is high time that efforts must begin at the individual level to reduce maternal mortality rates worldwide to make sure that we lead a happy and healthy life and don’t lag behind in achieving the Sustainable Development Goals. We should come together now to save ourselves and our planet.

Download Presentation  MMR & Sustainable Development

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