About 1000 women die from pregnancy- or childbirth-related complications around the world every day. This is referred to as Maternal Mortality. This is why I became an Obstetrician/Gynecologist.
In 2008, 358 000 women died during and following pregnancy and childbirth. Ninety nine percent (99%) occurred in developing countries, and most of them could have been prevented. More than half of these deaths occur in sub-Saharan Africa. The maternal mortality ratio in developing countries is 290 per 100 000 live births versus 14 per 100 000 in developed countries. Maternal mortality in the Unites States has declined dramatically over the past century. The rate declined from 607.9 maternal deaths per 100 000 live births in 1915 to 12.7 in 2007 (US Dept. of Health and human services report 2010).
Direct causes of maternal mortality:
• hemorrhage (postpartum and ante par tum)
• unsafe abortion
• sepsis
• obstructed labor
• ectopic pregnancy
• (Pre-) eclampsia and eclampsia
• embolism
Indirect causes of maternal mortality:
• Infectious and non-infectious diseases and other miscellaneous causes.
• Malaria
• HIV/AIDS
• hepatitis
• respiratory infections
• anemia
• sickle cell disease
• meningitis
• cerebrovascular diseases and others
Risk factor
•Access to skilled personnel
• Socioeconomic status
• Cultural practices
• Distance
• Lack of information
• Race
• Education
The leading causes of maternal deaths in the United States are hemorrhage, pregnancy-induced hypertension, embolism, infection, and other chronic medical conditions. In pregnancies with abortive outcomes, ectopic pregnancy is the leading cause of maternal death. .While maternal mortality from hemorrhage, PIH, and embolism has declined in the last 2 decades, maternal deaths due to other medical conditions, including Cardiovascular and neurological problems appear to have increased.
• Currently, the maternal mortality rates for most states as well as for all racial/ethnic groups fall short of the Healthy People 2010 goal- which was set at 4.3 deaths per 100 000 live births.
• While none of the racial/ethnic groups in 2007 met the 2010 target, the 2005-2007 maternal mortality rates for American Indian/Alaska Native women and non-Hispanic black women were 4 and 8 times higher than the 2010 target, respectively.
• The rising rate of cesarean deliveries may have also contributed to the apparent increase during the past decade.
• On the global stage, the United Nations member states have agreed to try to achieve eight Millennium Development Goals by the year 2015. This declaration was signed in September 2000 and aims to commit world leaders to combat poverty, hunger, disease, illiteracy, environmental degradation, and discrimination against women. The MDGs are derived from this declaration, and all have specific targets and indicators
• MDG 5 is to improve maternal health:
• Target 5.A. is aimed at reducing by three quarters, between 1990 and 2015, the maternal mortality ratio and Target 5.B. to achieve universal access to reproductive health by 2015.
Proposed intervention
• Individual: Health education will: increase awareness and improve health seeking behavior. Raise awareness to early signs of danger in pregnancy Improving the socioeconomic status of women in resource poor countries Encouraging counseling and testing for HIV
• Interpersonal Men’s participation is particularly important in addressing gender issues. These affect access to care in cultures where men are the main decision makers with regard to seeking health care.
• Cultural practices like female genital mutilation should be discouraged. Community leaders and faith-based organizations to remove cultural, religious and financial barriers.
• Organizational These include building human resources planning and management capacity both at the level of central government and within a facility, improving supervision, strengthening pre-service and in-service training and supervision, and developing health staff retention initiatives. Provision of healthcare facilities with emergency obstetric care, refurbishment of buildings, upgrading of operating theaters, labor and delivery rooms, maternity wards, laboratories, as well as provision of clean water, reliable electricity (e.g. a stand-by generator) and adequate waste disposal (e.g. a placenta pit).
• Community Financial barriers can be overcome by making maternal health services free of charge or by adopting creative and effective financing mechanisms such as community-based health insurance schemes, voucher systems, micro-credit schemes and community-based emergency transport funds. In almost all countries with low levels of maternal mortality, people do not pay for health services at the delivery point as the services are either free or are covered by a good health insurance system.
• Novel ways to ensure a good transport system between health facilities include means of transport other than the ‘traditional’ ambulance such as motor-cycle and bicycle ambulances which may be owned and managed by the community or the health centre. Currently, so many pregnant and non pregnant women travel all the way from Africa to seek medical care in the United States because of the very high maternal mortality in Sub Saharan Africa. We do our best to provide the best care we can.
The failure of implementation of laws and repercussions for negligence and malpractice in the developing countries has pushed middle class families to send their women to Europe and America for prenatal and Gynecological care. I hope we can come together and contribute in some way to reduce maternal mortality in Sub-Saharan Africa. Genesys Women Obgyn provides opportunities for women to bridge the gap between access and affordability of care. We have 2 offices – in the Houston and Sugar land area of Texas.