‘Most of the causes of maternal mortality are preventable: why is it then that women continue to be poorly nourished and to die during childbirth? Is child birth the cause of death, or is it a failure to diagnose, prevent and treat the reasons for maternal mortality (all connected with women’s status and the access to food, education and health care) responsible?
Vandana Shiva 1994
The Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), in article 12, specifically makes reference to maternal health and healthcare provision for women:
1. States Parties shall take all appropriate measures to eliminate discrimination against women in the field of health care in order to ensure, on a basis of equality of men and women, access to health care services, including those related to family planning.
2. Notwithstanding the provisions of paragraph 1 of this Article, States Parties shall ensure to women appropriate services in connection with pregnancy, confinement and the post-natal period, granting free services where necessary, as well as adequate nutrition during pregnancy and lactation.
One of the largest and most glaring differences between poor and rich countries is highlighted in the case of maternal deaths. According to the World Health Organisation, every two minutes a woman dies from pregnancy or childbirth-related causes – one third of these deaths occur in just 2 countries: India (20% of the global total – 56,000 deaths) and Nigeria (14% of the global total – 40,000 deaths).
A woman in sub-Saharan Africa has a 1 in 31 chance of dying in pregnancy or childbirth, compared to 1 in 4,300 generally in a developed country. 99 per cent of all maternal deaths occur in poorer countries with only 1 per cent occurring in rich countries indicating quite clearly that such deaths can be avoided with proper health services.
However, maternal deaths have reduced by almost 50 per cent in the last 20 years, from 540,000 deaths in 1990 to less than 290,000 in 2010. However, the annual rate of decline is less than half of what is needed to achieve the Millennium Development Goal (MDG) target of reducing the maternal mortality ratio by 75% between 1990 and 2015. This will require an annual decline of 5.5 per cent. The 47 per cent decline since 1990 translates into an average annual decline of just 3.1 per cent.
So while we wait for the statistics to catch up, women in developing countries remain vulnerable – they are 15 times more likely to die during pregnancy or childbirth than a woman in a developed country. The majority of the 40 countries with high maternal mortality rates are in sub-Saharan Africa where as many as 500 women die per 100,000 live births (10% of which are due to the aggravating effect of HIV infection on pregnancy).
Why does this happen?
- Political, cultural, economic, religious and social systems, including women’s status, limit the use of potential resources
- Inadequate and/or inappropriate knowledge, discriminating attitudes limit household access to actual resources.
- Lack of education, health information and life skills
- Insufficient access to maternity services – including emergency obstetric and new born care
- Inadequate maternal and new born health practices and care seeking
- Insufficient access to nutritious food and essential micronutrients including early and exclusive breastfeeding
- Poor water/sanitation and hygiene and inadequate basic health-care services
What needs to be done:
- Better access for women to good quality reproductive healthcare
- Better access to family planning
- Effective interventions
According to UNICEF:
- The gap in the risk of maternal death between the industrialised world and many developing countries, particularly the least developed, is often termed the ‘greatest health divide in the world’
- Since 1990, the global annual number of maternal deaths has exceeded 500,000. Limited gains have been made towards the first target of Millennium Development Goal (MDG) 5, which aims to reduce the 1990 maternal mortality ratio by three quarters by 2015. Progress on reducing maternal mortality rates has been virtually non-existent in sub-Saharan Africa
- Africa and Asia account for 95% of the World’s maternal deaths, with particularly high burdens in sub-Saharan Africa (50% of the global total) and South Asia (35%)
- Globally, during the period 2005–2010, over 50% of women received the recommended minimum antenatal care
Globally, around 57 million people die each year. Almost 15% of these deaths occur in children under the age of 5 years. Most of these preventable deaths in children occur in low- and middle-income countries. Some 6.9 million children under five years of age died in 2011 – nearly 19 000 children each day and almost 800 every hour. While progress has been made in recent decades, it is unequally distributed across regions and countries and within countries. Important challenges remain for the global goal to be achieved. About 80 percent of the world’s under-five deaths in 2011 occurred in only 25 countries, and about half in only five countries: India, Nigeria, Democratic Republic of the Congo, Pakistan and China. Together India (24%) and Nigeria (11%) account for more than a third of under-five deaths worldwide.
The biggest success story has been the massive reduction in the prevalence of measles which has dropped by 74% over the 10 year period. In 2000 more than 477,000 children died from measles and by 2010 that figure had dropped to less than 114,000. Some 85% of children 12-23 months worldwide have been immunised against measles.
In 2011, it was estimated that 1 in 6 children were considered underweight in developing countries. This combined with some of the largest populations, means that most underweight children (56 million) live in South-central Asia.
Global health trends
Non-Communicable diseases – a major health challenge of the 21st century
The WHO, in their Non-Communicable diseases (NCD) Surveillance strategy, report that in 1999 NCDs were estimated to have contributed to almost 60% of deaths in the world and 43% of the global burden of disease. If current trends continue, it is expected that by the year 2020 these diseases will account for 73% of deaths and 60% of the disease burden. Most of this increase is expected as a result of emerging NCD epidemics in developing countries. For developing and newly industrialized countries, the burden of disease from NCDs is expected to rise by more than 60%, compared to a rise of less than 10% in developed countries. The expected increases in an NCD epidemic is the increase in lifestyle related risk factors resulting from social and economic changes – the impact of globalisation.
Of the estimated 57 million global deaths in 2008, 36 million (63%) of them were due to non-communicable diseases (NCD) such as heart disease, stroke, cancer, chronic respiratory diseases and diabetes, which are considered the leading cause of mortality in the world. One of the main contributors to heart disease and stroke is high blood pressure which is directly responsible for 51% of stroke deaths and 45% of deaths related to coronary heart disease. In 2000 high blood pressure was responsible for 7.5 million deaths – that’s 12.8% of global deaths. The situation has improved in developed countries with improved diagnosis and treatment, however in Africa, the number of people with high blood pressure is on the increase – estimated at a third of the continent’s population.
Behavioural factors including tobacco use, physical inactivity, unhealthy diet, and the harmful use of alcohol are estimated to be responsible for about 80% of coronary heart disease and cerebrovascular disease.
HIV and AIDS
Since the beginning of the epidemic, more than 60 million people have been infected with the HIV virus and approximately 30 million people have died of AIDS. In 2010, there were an estimated 34 million people living with HIV, 2.7 million new infections, and 1.8 million AIDS-related deaths. The WHO African Region is the most affected, where 1.9 million people acquired the virus in 2010. The estimated 1.2 million Africans who died of HIV-related illnesses in 2010 comprised 69% of the global total of 1.8 million deaths attributable to the epidemic.
Number of people (all ages) living with HIV – 34.0 million people were estimated to be living with HIV worldwide in 2010.
Number of women and children living with HIV – an estimated 3.4 million children were living with HIV worldwide at the end of 2010.
Prevalence of HIV among adults aged 15 to 49 years – globally, 0.8% of the adult population were living with the HIV virus in 2010, while the WHO African Region is the most affected at 4.7%.
Number of deaths due to HIV – 1.8 million people died of AIDS-related illnesses worldwide in 2010.
Malaria occurs in 99 countries. Currently, about half of the world’s population is at risk of malaria, with an estimated 216 million cases globally in 2010 – leading to 655,000 deaths (86% of whom were children under five years of age). In eight countries within the WHO Africa Region, there was more than a 50% reduction in confirmed malaria cases, admissions and deaths. In other WHO regions, the number of reported cases of confirmed malaria decreased by more than 50% in 35 of the 50 countries with on-going transmission between 2000 and 2010. The global estimated incidence of malaria fell by 1.8% annually between 2000 and 2009. This is due to interventions such as the distribution of insecticide treated nets and indoor spraying. This will need to be sustained in order to prevent resurgence.
The annual number of new cases of TB has been falling since 2006. In 2010, 8.8 million new cases were reported – 13% of which occurred in people living with HIV. 1.1 million HIV negative people died from TB, while an additional 350,000 HIV positive people died from HIV-assisted TB. Mortality from TB has fallen by over one third globally since 1990, although there are some regional variations on this figure. Although treatment success rate reached 87% worldwide in 2009, multi-drug resistant TB continues to present significant problems.
“The world is getting heavier” says the WHO. It is estimated that worldwide some 2.8 million people die as a result of being overweight or obese. The risks include coronoary heart disease, ishaemic stroke, type II diabetes mellitus and some common cancers. Between 1980-2008 the worldwide prevalence of obesity almost doubled. By 2000 some 10% of men and 14% of women in the world were classified as obese – that’s half a billion people. The region with the highest prevalence is the region of the America’s where 62% of the population are overweight. South-East Asia has the lowest incidences with 14% overweight and 3% obese.
- WHO Maternal Mortality – Interactive Map
- WHO Non-Communicable diseases (NCD) Surveillance strategy
- Progress in health-related Millennium Development Goals, see this fact sheet from WHO.
- World Health Statistics 2012