Safe Motherhood
Reducing Maternal Mortality

By Jhabindra Bhandari

IN a country like Nepal where primary health care services are limited in the rural areas, the status of reproductive health presents a gloomy picture. Lack of awareness on health and education including poor health care services are the major issues of public health. High infant and maternal mortality, rapid population growth , poor nutritional status, poor sanitation and lack of awareness on health issues are causing negative impacts on public health.

Grim Reality

Nepal has one of the highest maternal mortality rates in the world. The maternal mortality rate is 539 per 100,000 live births and hence this pinpoints the grim reality of maternal health in the country. Majority of women do not have access to maternal health care services due to a number of social, economic and cultural factors. Therefore, a multi-sectoral approach is needed to include both health and non health interventions that promote access to health services.

Safe motherhood is one of the priority programmes of Ministry of Health. According to the annual report of Department of Health Services - 2000/2001, the target of safe motherhood programme is to contribute to the reduction of maternal mortality rate from the rate of 539 per 100,000 live births to 400 per 100,000 live births by the end of the Ninth Five Year Plan period and 250 by 2017. Similarly, the other important target is to contribute to the reduction of infant mortality rate from 78 per 1,000 to 34.4 by 2017.

According to the report of WHO - South East Asia Region 2001, more than 60 per cent of maternal deaths occur after birth, more than half of these take place within one day of delivery globally. Some 80 per cent of all maternal deaths occur due to direct obstetric complications. Thus maternal death is a tragic outcome of continuing societal neglect of women's health, their unequal access to life-saving emergency obstetric care, and their lack of decision making power.

Over the last two decades, countries of South East Asia region have made concerted efforts to promote safe motherhood since the global launching of the safe motherhood initiative in 1987. The region that is home to nearly half of the world's poor and women, are affected by poverty. The region accounts for 40 per cent of global maternal deaths.

The declaration on health and development in the South East Asia Region in the 21st century has identified reduction of maternal mortality as one of the foremost challenges advocated for public health actions. Despite these efforts, maternal and new born deaths have remained high in the region. Thousands of women continue to die in child birth which is the leading cause of death among women of reproductive age in the region.

The three delays are quite particular which may lead to death of a pregnant woman and a new born baby. Firstly, the delay is related to lack of knowledge about the dangerous signs and need for skill attendant at delivery. It means there is delay in decision making in case of the complications. Secondly, there is a delay in reaching the health facilities due to lack of community awareness and poor use of available community resources. And thirdly, there is a delay in receiving proper treatment due to poor management and quality of existing health services.

The role of families and communities is to encourage, empower and facilitate women to seek health care and family planning services. Massive awareness against dangerous signs and complications during pregnancy and delivery is most vital for timely referral and care. This means that social mobilisation is one of the strategies to overcome the three delays in seeking and receiving care. Local NGOs can contribute by supplementing and complementing the government's efforts of achieving safe motherhood to reduce maternal and neonatal mortality significantly.

Pragmatic strategies to reach the goal of safe motherhood are required. Efforts are urgent to take place in order to strengthen and expand basic maternal care services including family planning. On the other side, there is growing need to establish functional referral and transport systems from communities to district hospitals for obstetric emergencies and high-risk pregnancies. At the village level, it is high time to strengthen community-based maternity care services through Female Community Health Volunteers, Maternal Child Health and Workers and Traditional Birth Attendants.

Important

In order to promote inter-sectoral collaboration for safe motherhood, advocacy for reproductive health, including safe motherhood at all levels and capacity building of service providers are extremely important. Similarly, participatory operational research on safe motherhood contributes significantly to improve planning for quality services and more cost -effective interventions. Information, Education and Communication activities need to be expanded effectively in the communities to improve health seeking behaviour. More importantly, mainstreaming safe motherhood issues in local development plans and programmes is crucial to reduce maternal mortality - thereby raising the status of women in society.

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