July 9, 2009 – Regular doctor visits, sonograms and various tests constitute routine prenatal care for pregnant women in developed countries. But for Adwoa, an expectant mother in Ghana, access to such health care is unavailable.
Instead, for too many other women in sub-Saharan Africa, pregnancy often can lead to painful long-term disability or death for the woman or her children.
This wide discrepancy on maternal health is the unfortunate message on the 20th anniversary of World Population Day, July 11.
Reducing maternal mortality by three quarters, and achieving universal access to reproductive health services is one of the Millennium Development Goals the international community set to achieve by 2015 to improve the lives of poor people. But the world is showing the least progress on this goal, according to the latest Global Monitoring Report.
“One of the best guarantees for getting countries on the faster track to less poverty and more opportunity is investing in maternal health and reproductive health programs,” says Joy Phumaphi, World Bank Vice President for Human Development, Chair of the Partnership for Maternal and Child Health and former health minister in Botswana.
But support for population and reproductive health programs has significantly declined as a percentage of overall global health aid, from about 30 percent in 1994 to 12 percent in 2008.
Every minute, a woman dies of complications related to pregnancy and childbirth from mostly preventable and treatable medical problems, which adds up to more than 500,000 women each year, according to UNFPA.
For every woman who dies, another 20 suffer injuries and disabilities that can last a lifetime, robbing them of livelihoods and physical well-being.
In sub-Saharan Africa, a woman’s risk of dying from treatable or preventable complications of pregnancy and childbirth over the course of her lifetime is 1 in 16, compared to 1 in 2,800 in the industrialized world. And 1 in 11 children in Africa is likely to die before reaching his or her first birthday.
Also, fertility rates continue to be high—more than five live births per woman--in 35 poor countries in the world, mostly in Africa.
Progress So Far
In recent decades, many countries have made progress in reducing maternal mortality and lowering fertility rates. For example, maternal mortality rate in Egypt fell from 174 to 84 per 100,000 live births through better access to family planning and births in health facilities supervised by trained birth attendants. Bangladesh reduced fertility rates from over 7 children per woman in 1970 to about 2.7 children per woman today, while infant mortality fell from 105 per 1,000 live births in 1990 to 47 in 2007.
Also, national public information campaigns have galvanized support to reduce maternal-related disabilities such as fistula, a painful rupture in the birth canal that occurs during prolonged, obstructed labor, which leaves women incontinent, isolated and ashamed.
But huge challenges remain as aid for family planning and reproductive health programs has not kept pace with demand.
Fertility Rates Impact Economic Growth
High fertility rates, along with inadequate health care, impede development and economic growth.
Investing in family planning and reproductive health programs is not only vital to saving women’s lives, but also to boosting women’s economic and social well-being, improving the lives of their children and families, and reducing endemic poverty.
“The longer it takes for countries to move to a low-fertility, low-mortality pattern, the greater the danger that high-birth rate countries will continue to experience greater inequalities in education, jobs, life expectancy, and adult prevalence of HIV/AIDS, than their wealthier counterparts,” says Phumaphi.
Family size can also greatly affect women’s jobs in the workplace, according to a recent World Bank report, Population Issues in the 21st Century: The Role of the World Bank. One cross-national survey suggests that the percentage of women in the labor force is directly related to national birth rates. In Bolivia, there were strong links between women using contraception and having jobs outside of the home. In the Philippines, the average income growth for women with 1-3 pregnancies was twice that of women who had been pregnant more than 7 times.
Ensuring Health Systems Can Deliver
The World Bank and several of its international development partners —including UNFPA, the UN Children’s Fund (UNICEF) and the World Health Organization (WHO)—have pledged to work together over the next five years to help countries strengthen their health systems, from rural clinics to major urban hospitals -- to achieve the MDG5 targets.
For its part, the Bank has provided about $950 million in loans and grants for maternal and reproductive health programs, with another nearly $350 million in the pipeline. This financial support is provides an array of vital services to poor women and their families, including access to contraception information and services, health insurance, improved pre-natal care, provision of skilled birth attendants, access to insurance and emergency obstetric services, and post-natal care.
Population and Reproductive Health Facts:
- More than 500,000 women die each year during pregnancy and childbirth – mostly in developing countries and mostly from preventable and treatable medical problems.
- 1 in 16 women is likely to die from pregnancy-related causes in Sub-Saharan Africa, with the world’s highest rates of maternal mortality — at least 100 times those in developed countries.
- 35 countries, also mainly in Sub-Saharan Africa, continue to have a total fertility rate of more than 5 live births per woman -- adversely affecting progress in reducing poverty.
- Access to voluntary family planning could reduce maternal deaths by 25 to 40 percent, and child deaths by as much as 20 percent.
- Maternal and newborn mortality costs an annual $15 billion in lost productivity.
