Poor care marked by two extremes: too little, too late, with untimely, insufficient care, and too much, too soon, with over-medicalisation and excessive, unnecessary interventions
By Anastasia Moloney
BOGOTA, Sept 15 (Thomson Reuters Foundation) - Unequal access to health services and poor quality care for pregnant women is hampering progress in meeting international goals for eradicating deaths during childbirth, researchers said on Thursday.
U.N. member states agreed a year ago to reduce the rate of maternal mortality, defined as a woman's death during pregnancy, childbirth or within 6 weeks after birth, to fewer than 70 per 100,000 live births globally by 2030 as part of the U.N. Sustainable Development Goals (SDGs).
Globally maternal deaths have nearly halved since 1990 - falling to 216 women dying of maternal causes per 100,000 live births in 2015 from 385 per 100,000 in 1990.
But to reach the U.N. target, maternal mortality rates would need to fall by nearly 70 percent, researchers said in a study published in The Lancet.
Nearly 53 million of the poorest women in the world receive no skilled assistance during birth, the study said.
Women who struggle the most to get good quality maternal care were teenagers, unmarried women, immigrants, refugees and internally displaced women, along with indigenous women and women from ethnic or religious minorities, the report said.
"In all countries, the burden of maternal mortality falls disproportionately on the most vulnerable groups of women," said Wendy Graham, lead author of the study and professor of obstetric epidemiology at the London School of Hygiene and Tropical Medicine.
"This reality presents a challenge to the rapid catch-up required to achieve the underlying aim of the Sustainable Development Goals - "to leave no one behind"," she said in a statement.
Most maternal deaths occur in developing countries, often caused by unsafe abortions, excessive bleeding, high blood pressure or infection during pregnancy, childbirth or the period shortly after delivery, health experts say.
WIDENING GAP
The gap between countries with the lowest and highest maternal mortality rates has doubled between 1990 and 2013 and huge differences exist within countries, including rich countries like the United States, the report said.
For example, African-American women in New York City are twice as likely to die in childbirth as women living in the developing region of Eastern Asia, it said.
In sub-Saharan Africa, the risk of a women dying in pregnancy or childbirth during her lifetime remains 1 in 36 women compared with 1 in 4,900 in richer countries, it added.
To meet the SDGs, an estimated 18 million additional health workers are needed, including midwives and obstetricians, particularly in sub-Saharan Africa, the report said.
Researchers said too many birth facilities still lack basic equipment, water, sanitation and electricity.
The report said a trend of over-prescribing tests, antibiotics after birth, unnecessary caesarean delivery and induced labour also amounted to poor maternal healthcare.
"Too many experience one of two extremes: too little, too late, where women receive care that is not timely or sufficient, and too much, too soon, marked by over-medicalisation and excessive use of unnecessary interventions," the report said.
The problem of over-medicalisation has traditionally been found in rich countries but it has become more common in low-and middle-income countries, bringing higher health costs and the risk of harm, the report said.
(Reporting by Anastasia Moloney, Editing by Katie Nguyen.; Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers humanitarian news, women's rights, trafficking, corruption and climate change. Visit http://news.trust.org)
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