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Poor quality care hampers maternal health goals

Friday September 16th, 2016

Poor quality care and increasing 'over-medicalisation' of maternal health care are among the issues hampering progress of achieving the UN’s sustainable development goals, according to a report published today.

As the 71st UN General Assembly convenes, The Lancet has published a series of six papers on global maternal health, covering the epidemiology of maternal health, the current landscape of maternal health care and services in both high and low income countries, and future challenges and strategies to improve maternal wellbeing.

The papers reveal that while progress has been made in reducing maternal mortality globally, stark differences remain at international and national levels, with the gap between the groups of countries with the lowest and highest rates of maternal mortality doubling between 1990 and 2013.

Series author Professor Wendy Graham, London School of Hygiene & Tropical Medicine, London, said: “In all countries, the burden of maternal mortality falls disproportionately on the most vulnerable groups of women. 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’.”

Paper three describes how an increasing number of mothers are using birth facilities, but the quality of care varies. However, about one quarter of babies worldwide are delivered without the presence of a skilled birth attendant.

The authors point out that although facility and skilled birth attendant deliveries are increasing in many low income countries, the phrases ‘skilled birth attendant’ and ‘emergency obstetric care’ can mask poor quality care.

They also warn that many birth facilities lack basic resources such as water, sanitation and electricity.

Series author, Professor Oona Campbell, London School of Hygiene & Tropical Medicine, said: “It is unethical to encourage women to give birth in places with low facility capability, no referral mechanism, with unskilled providers, or where content of care is not evidence-based. This failing should be remedied as a matter of priority.”

In high-income countries, rates of maternal mortality are decreasing but there is still wide variation at national and international level. For instance, in the USA the maternal mortality ratio is 14 per 100,000 live births compared to 4 per 100,000 in Sweden, another paper reveals.

One of the papers also highlights the problem of over-medicalisation, which has historically been associated with high-income countries. It is now more common in low and middle income countries, increasing both health costs and the risk of harm.

The authors of the Series also identify five key priorities that are required to achieve the SDG global target of a maternal mortality ratio of less than 70 per 100,000 live births.

These include prioritising quality maternal health services that respond to local needs, promoting equity through universal coverage of quality maternal health services, improving the health workforce and facility capability, and guaranteeing sustainable financing for maternal and perinatal health.

Lancet 16 September 2016

Tags: Childbirth and Pregnancy | UK News | Women's Health & Gynaecology | World Health

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