Most at risk of maternal death

The poorest and most marginalised women continue to face the highest risk of death from causes related to pregnancy and childbirth. Efforts must be drastically increased to safeguard the maternal health of all women everywhere, if the good health and well-being of all people – and in turn the well-being and prosperity of communities and societies – are to be achieved.

The World Health Organisation (WHO) estimates that 830 women die every day from preventable causes related to pregnancy and childbirth. Considerable progress has been made on a global level to reduce maternal mortality – between 1990 and 2015, maternal mortality worldwide dropped by about 44%.

Diversity and difference

An article published in The Lancet series, which chiefly examines data on maternal mortality and morbidity, highlights how inequalities in maternal health are becoming more diverse and uneven, both within and between populations and countries. The authors note the importance for countries to recognise this uneven distribution of poor maternal health to ensure effective planning and implementation of actions to improve health. This includes the need to address inequities in wealth, socio-economic status, human rights and access to health-care.

Too little, too much

Another article published as part of The Lancet series, further highlights this growing diversity and difference in maternal health, in relation to the nature and quality of health-care given to women during pregnancy and childbirth. It compares two extreme situations in maternal health-care provision: one which the authors term 'too little, too late', and the other 'too much too soon'.

'Too little too late' refers to inadequate provision of health-care, including care with insufficient resources, poor quality care given with below-evidence standards, or care which is withheld or unavailable until it is too late. This often applies in low- and middle-income countries, which have seen a push towards births in facilities which have inadequate and poorly trained staff, insufficient infrastructure and commodities, and a lack in evidence-based practice. This can often result in poor quality care that puts women and girls lives at greater risk during pregnancy and childbirth.

'Too much too soon' refers to the unnecessary use of interventions which are not based on evidence, as well as the use of interventions which have the potential to be life-saving when used appropriately, but harmful when applied routinely or used too much. This situation, characterised by excessive medicalisation, is becoming more widespread in middle-income countries, and is associated with disrespect and abuse of women in health-care facilities.

Global Strategy for Women's, Children's and Adolescents' Health

During the United Nations General Assembly 2015, in New York, UN Secretary-General Ban Ki-moon launched the Global Strategy for Women's, Children's and Adolescents' Health, 2016-2030. The Strategy is a road map for the post-2015 agenda as described by the Sustainable Development Goals and seeks to end all preventable deaths of women, children and adolescents and create an environment in which these groups not only survive, but thrive, and see their environments, health and wellbeing transformed.