Major highlights from the Lancet’s Maternal Health Series

The series was guided by the paramount message below

“Every woman, every newborn, everywhere has the right to good quality care.”

www.maternalhealthseries.org

The adopt primarily a numerical lens to illuminate patterns and trends in outcomes but recognise that understanding of poor maternal health also warrants other perspectives, such as human rights (Graham et al., 2016). Although there has been progress observed in the reduction of maternal mortality rates across the world, there are still some countries that recorded little or no advances in the reduction of women dying as a result of pregnancy.
For example, Nigeria has one of the world’s worst indices for maternal mortality rate, with an estimated lifetime risk of maternal death being 1 in 31 compared to that of high resource countries (1 in 3700) (Agboghoroma & Gharoro, 2015; Njemanze & Okoro, 2015). The growing loss of women’s lives in Nigeria due to avoidable factors occurring under preventable conditions remains a worrisome issue.

The series highlights the major causes of maternal deaths and the critical interventions as seen in the figure below:

Universally, every woman deserves the right to good quality woman-centred maternal health care. The series informs us that there are issues in the maternal health sphere across high-middle-low income countries. On one hand, there is a growing risk of over-medicalization of healthy pregnancy and birth, while on the other hand, poor quality care that is too little, too late jeopardises the women;s health.

There is a shift seen from avoidable deaths to an increasing array of maternal morbidities, as more women survive childbirth. The diversity and divergence in the burden of poor maternal health across the world are as a result of four major transitions. These include demographic, epidemiological, socioeconomic and environmental. Contrary to popular belief that poor quality care is mostly always seen in low-income developing countries, it is an issue present in all countries. Although some women receive excellent care, a lot experience one of two extremes: too little too, too late, or too much, too soon.

Too little, too late
•    Lack of evidence-based guidelines
•    Lack of equipment, supplies and medicines
•    Inadequate numbers of skilled providers
•    Women delivering alone
•    Lack of emergency medical services and delayed inter-facility referrals

Too much, too soon
•    Unnecessary caesarean section
•    Routine induces or augmented labour
•    Routine continuous electronic fetal monitoring
•    Routine episiotomy
•    Routine antibiotics postpartum

It is recommended that particular, context-appropriate strategies and guidelines are needed to counter both extremes.

One salient point to never forget is that the burden of maternal health mortality and severe morbidity is concentrated among vulnerable population, especially those that face gender and other discrimination, have financial constraints, are affected by humanitarian crisis or live in fragile state or areas prone to natural disasters.

The series concludes with a five-point agenda for change:
•    Good quality care for every woman, every new-born, everywhere
•    Equity through Universal Health Coverage
•    Health system resilience, strength and responsiveness
•    Sustainable financing for maternal and new-born health
•    Better evidence, advocacy, and accountability for progress

As a matter of priority, widening gaps or differences in the rates of maternal deaths seen across the world, especially amongst the vulnerable population has to be addressed. There needs to be strong political will and commitment from all the stakeholders to improve equity. Progress on the issue of reducing maternal deaths will ultimately be the judge of sustainable development.

Please leave your comments, and checkout the full executive summary of the maternal health series here