Safe Motherhood
Empower Women, Ensure Choices

By Jhabindra Bhandari & Indra Rai

MATERNAL Mortality is still the leading cause of death among women of reproductive age in most of the developing countries. In spite of several attempts of national governments, Non Government Organisations (NGOs) and private sectors to fight against this tragedy, saving the lives of millions of women during their pregnancy and childbirth is a big challenge. In order to reduce the high maternal mortality and morbidity, community-based safe motherhood programmes should focus on the empowerment of women in order to ensure their choices.

If we look at the scenario of the worlds’ maternal health status and the provision of maternity services, it presents a gloomy picture, particularly in developing countries. And the needs of the health care services are potentially large. The World Health Organisation (WHO) estimates that at least half a million women die as a result of pregnancy and child birth in the world every year, and almost 99 per cent of these deaths occur in the developing world. Every minute of day, somewhere in the world, a woman dies as a result of complications arising during pregnancy and childbirth.

In South Asia alone one maternal death occurs every two minutes. South Asia houses 22 per cent of the world’s population, but accounts for 50 per cent of the world’s maternal deaths. These deaths are largely due to bleeding, pre-eclampsia, eclampsia, puerperal sepsis, prolonged/obstructed labour and unsafe abortion. More importantly, the majority of these deaths are avoidable if quality maternity services in the communities are available.

Recognising the gravity of the problem, the global Safe Motherhood Initiative was launched at an international conference held in Nairobi, Kenya in 1987 with the prime objective of drawing attention to the dimensions and consequences of poor maternal health in developing countries. More important was the need to mobilise action to address high rates of death and disability cause by the complications of pregnancy and childbirth. The initiative set a vision to reduce the maternal mortality by half by the year 2000.

The 1994 International Conference on Population and Development in Cairo and the 1995 Fourth World Conference on Women in Beijing were the next major landmarks. Each of these conferences gave substantial attention to maternal mortality as a visible sign of historical neglect of women’s health and women’s needs. The Cairo conference explicitly defined safe motherhood as one of the important components of reproductive health.

Limited access to and control over resources have affected heavily on the lives of women. So, empowerment of women and gender equity are necessary conditions for improved access to health care. Unfortunately, a wide range of social and cultural barriers has directly or indirectly limited women’s access to health services. These factors include inadequate education, low social status, and lack of income and employment opportunities. Therefore, safe motherhood programmes need to address these issues in a holistic approach for improving maternal health in the long term.

Multi-sectoral strategies that influence women’s educational, social and economic status can play a vital role in improving women’s health. Social mobilisation is key to improve the socio-economic status of women. In this regard, community awareness regarding the danger signs of pregnancy and child birth need to be raised through a series of IEC campaigns in order to increase access to health care.

Women participation in planning, implementation, monitoring and evaluation of health care programmes is essential to make community interventions responsive to women’s needs and choices. Yet, the practice is the different one. Moreover, it is important to note that safe motherhood is a vital social and economic investment, as poor maternal health has a direct negative impact on the well being of the children and the families.

Improving the maternal health situation in Nepal should be an important priority because maternal death is the largest cause of death for women of reproductive age. According to annual report of Department of Health Services 1997/98, the national target is to contribute to the reduction of maternal mortality rate to 400 per 100,000 live births from the present estimated rate of 539 per 100,00 live births by the end of the ninth five year plan.

In a country like ours where majority of the population live in rural areas have limited access to health care. Due to the widespread poverty and illiteracy, the public health faces many challenges. The health facilities are unable to provide quality health care services to the entire population as the common problem of inadequate drugs and trained service providers still exists. Awareness raising programmes in the communities are still limited, and even if they exist are not effective because of poor coordination and intersectoral collaboration.

There is still poor community awareness of the problems and risks women face during pregnancy and childbirth. More specifically the knowledge and concern over obstetric danger signs are also low. As a result, the rural talks delay in deciding to seek care, in reaching care and in receiving care. Besides, safe motherhood is most often not perceived as a sensitive issue in families and communities. Again, there are a few health facilities providing essential obstetric care and at the same time the services are of poor quality. So encouraging community initiatives to prepare for emergencies is crucial to save women’s lives.

After all, safe motherhood means ensuring that all women have access to the information and care they need to go safely through pregnancy and childbirth. Reducing maternal mortality requires sustained, long- term commitment and inputs from a range of partners. Therefore, safe motherhood must be a priority of governments, policy makers, health providers, and civil society. Recognising that high maternal death rate is an alarming social tragedy and a threat to public health, there should be a strong commitment from governments, NGOs, and community organisations to work together to achieve the national goal of reducing high maternal mortality.

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