Saving Asia's mothers

BANGKOK – With all the talk about the impending “Asian century,” one might imagine that the region had moved beyond what are often viewed as poor-country health challenges, like high rates of maternal mortality. The reality is very different. In 2015, an estimated 85,000 women died of complications related to pregnancy and childbirth across the Asia-Pacific region – 28% of the global total. Up to 90% of those deaths, which were concentrated in just 12 countries, could have been prevented through quality antenatal, obstetric, and perinatal care. In the absence of such care, the average maternal mortality rate (MMR) in the Asia-Pacific region is extremely high: 127 per 100,000 live births, compared to the developed-country average of 12 per 100,000. The 12 countries with the highest MMRs, exceeding 100 deaths per 10,000 live births, are Afghanistan, Bangladesh, Cambodia, India, Indonesia, Laos, Myanmar, Nepal, Pakistan, Papua New Guinea, the Philippines, and Timor-Leste. These countries, together, accounted for about 78,000 known maternal deaths in 2015. The actual figure is probably higher. In fact, MMRs are notoriously difficult to estimate, with conflict, poverty, poor infrastructure, weak health systems, and inadequate resources causing many deaths to go unreported. MMR data do, however, provide an indication of general trends, which are not promising. Indeed, if they persist, hundreds of thousands of mothers in those 12 high-MMR Asia-Pacific countries alone could lose their lives by 2030. To be sure, substantial progress has been made in the last 15 years, and efforts are being made to sustain it. The United Nations development agenda, underpinned by the Sustainable Development Goals (SDGs), aims to reduce the MMR to 70 deaths per 100,000 live births by 2030. If that target is met, up to 100,000 lives could be saved across the Asia-Pacific region. Achieving the goal presupposed faster progress, with annual rates of MMR reduction particularly low (2%) in Papua New Guinea and the Philippines. On current trends, only four of the Asia-Pacific region’s 12 high-MMR countries will be able to meet the SDG target for maternal mortality. The remaining eight will require an average of 26 years. At a time when family-planning policies are becoming increasingly restrictive, accelerating the pace of progress could prove difficult. Indeed, for some countries, progress is at risk of slowing. The UN Population Fund (UNFPA) is working hard to counter this trend. We are committed to ensuring that all pregnancies are safe and wanted, and that all women and girls are empowered not just to make their own choices about their own families and bodies, but also to contribute more to poverty reduction and economic development. In the 12 high-MMR Asia-Pacific countries, the UNFPA advocates the development of responsive and inclusive health systems with sufficient numbers of trained personnel, from midwives to community-health workers. And we are already working to advance that objective. In Afghanistan, the UNFPA and its partners have supported the expansion of community health services, including the creation of 80 family health houses and nine mobile support teams. Those initiatives had reached more than 420,000 people by 2015. In Lao PDR, the UNFPA has helped the Ministry of Health train midwives and village health volunteers to provide basic sexual and reproductive care, providing the information that women need to avoid unwanted pregnancies. This contributed in a steep drop in the MMR, from 450 to 220 per 100,000 live births, between 2005 and 2015. In Fiji, the UNFPA, with the support of the Australian government, pre-positioned thousands of dignity and reproductive-health kits. Following the devastation caused by Cyclone Winston in February 2016, these strategically placed supplies help to address women and girls’ immediate reproductive-health needs, saving the lives of mothers and children. But, while such initiatives are already having a powerful impact, more investment must be channeled toward ensuring that comprehensive health services are available and accessible to all, especially the most vulnerable groups. In particular, additional resources must be allocated to sexual- and reproductive-health services – and to ensuring access to them. Strengthening the provision of antenatal care, ensuring safe delivery through skilled birth attendance, and expanding emergency obstetric care are all key interventions that can reduce MMRs across the region. Of course, women also need access to family-planning services, to help them avoid unwanted pregnancies and reduce the number of unsafe abortions. The rights of all women and their partners to choose the family-planning method that is appropriate for them must be respected, and a full range of quality contraceptives must be readily available to all. When women have full control over their sexual and reproductive health, society as a whole reaps enormous benefits. In fact, every $1 invested in modern contraceptive services can yield as much as $120 in social, economic, and environmental returns. Such investment should come partly from international development assistance, which must place a higher priority on sexual- and reproductive-health services, and partly from national governments. But money is not all governments can offer. They can and must develop inclusive policies that address the needs of vulnerable and marginalized groups, including in ways that go beyond the health sector. This includes fighting harmful practices such as child marriage and gender-based violence; removing legal barriers to contraception; and working with communities to address misconceptions around sexual and reproductive health. Safe pregnancy and childbirth should be a top priority for all societies, as it is for the UNFPA. If we are to meet the SDG target for maternal mortality, we must work together to advance targeted, tailored interventions that respect the rights of women and girls to make decisions about their sexual and reproductive health. Anderson Stanciole is a Health Economics Advisor at the United Nations Population Fund’s Asia-Pacific Regional Office. Federica Maurizio is Health Economics and SRHR Fellow at the United Nations Population Fund’s Asia-Pacific Regional Office. Copyright: Project Syndicate.

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Saving Asia's mothers