Poorer

Maternal mortality is a problem that, above all, afflicts the world’s poorer populations. It is practically non-existent for those who have access to health and medical care. In Sweden, 4 women die for every 100,000 births. In India, on the other hand, the equivalent figure is 200 while in Nigeria maternal mortality amounts to 600 for every 100,000 births. Every day, 800 women around the world die due to pregnancy or childbirth.
 

Life and death

The most common reasons for death associated with pregnancy and birth are: loss of blood, infections, low blood pressure and unsafe abortion practices. During the last twenty years, ample resources have been invested in improving medical care for women in childbirth in those countries in need. Still much work remains to be done.
At the same time, many women either choose, or are forced, to give birth without access to professional medical help. Being able to call on the services of a health facility where complications during birth can be handled may make the difference between life and death.
 

Two strategies

“We know what is required to prevent these deaths. Women all over the world must have access to properly qualified personnel when giving birth, and to emergency care with facilities for carrying out caesarean sections and blood transfusions if complications arise”, says Aysha De Costa, Coordinator of the research project MATIND. This project aims to evaluate two different strategies to get more women from groups in a position of socio-economic vulnerability to give birth in hospital.
 

Nursing fee

India currently accounts for just under a quarter of maternal mortality worldwide. The state of Gujarat on India’s west coast is relatively rich and has 60 million inhabitants. Here, the private care sector is dominant and 90 per cent of the state’s obstetricians are private employees. The medical care is financed through fees charged to each individual patient. In order to provide access to specialist obstetricians for more women, the state pays private hospitals a fixed sum of money on every occasion that women who cannot afford to pay the nursing fee give birth. In this way, these women, with the highest maternal mortality rate in India, receive free healthcare.
 

Maternity wards

Next to Gujarat lies the state of Madhya Pradesh where the situation is different. Madhya Pradesh is a poor state with 72 million inhabitants most of whom live in the countryside. Most of the hospitals are state run and maternity wards are found in only a few of the state’s cities. The state pays every expectant mother a sum equivalent to € 15 if she decides to give birth in a state-run hospital.
 

Dramatic rise

Thanks to both these strategies, the number of Indian women who give birth in hospitals has risen substantially. Over the past four years, for example, no less than 650,000 women in Gujarat, who would previously not have called on institutional medical care for a variety of reasons, have had their children delivered in hospitals. In Madhya Pradesh, over a million women have given birth in public sector hospitals in the last five years, an increase of 40%.
 

Ongoing research

However, it is uncertain whether the increased share of hospital births results in reduced maternal mortality since the hospitals cannot always provide adequate medical care. Ongoing research will determine whether the two strategies have led to positive effects on maternal mortality.
 

More women

“These strategies illustrate two different ways of getting more women to utilise existing medical care facilities. By simultaneously working to improve the standards of care for women in childbirth, we can hopefully approach the UN’s millennium goals of cutting maternal mortality by three-quarters by the year 2015. Every woman, regardless of whether she lives in Sweden, India or Nigeria, shall have the right to, and the possibility of, the safest childbirth possible”, says Ayesha Da Costa.
 

Film

Watch this YouTube film on maternal mortality.