Tuesday, June 09, 2009

The ties that bind: untangling the socio-political context of Maternal and Child Health

Maternal and child health (MCH) is not an entirely new concern, but its inclusion in the Millennium Development Goals (MDG) gave its attainment priority status. Goal 4 calls for the reduction of under-fi ve mortality by two-thirds by 2015, while Goal 5 aims to reduce maternal mortality rate by three-quarters.

Barely six years before the deadline, the global community still has a lot of catching up to do. At best, efforts to reduce maternal and child mortality ratios produce patchy results, with some countries attaining a level of success, while
others further slide down the ladder.

Maternal health

According to The Millennium Development Goals Report 2007, while child mortality
is on the decline, more than half a million women worldwide still die of pregnancy and/or childbirthrelated complications every year. In the Asia-Pacific region, South Asia posted the highest maternal mortality ratio of 546 deaths per 100,000 live births in 2000. East Asia, on the other hand, had the lowest ratio of 55 per 100,000 live births. From 1997 – 2002, 31 percent of maternal deaths in Asia was due to hemorrhage.

The availability of health services before, during, and after pregnancy is a key factor in reducing maternal death. In East and Central Asia, where maternal deaths are lower than in other Asian regions, the percentage of births attended by skilled personnel is signifi cantly higher at 79 percent and 99 percent, respectively. South Asia, on the other hand, had the lowest percentage of 36 percent. The socio-economic divide is very evident in the chasm between developing and developed countries. As a whole, developing countries have a maternal mortality rate of 450 per 100,000 live births, as compared to 14 per 100,000 live births in developed regions.

Child health

Child mortality rate is largely on the downtrend, owing mainly to an expanded immunization coverage. In a period of five years (2000 to 2005), deaths from measles have gone down by more than 60 percent. However, more pressing concerns are needed to be addressed in order to make a signifi cant and lasting impact on child health. A press release from the UN Economic and Social Commission for Asia and the Pacific noted that the region accounts for more than 65 percent of the world’s undernourished children.

In the 2005 World Health Report, the World Health Organization called attention to the needs of newborns, which have been largely ignored. According to the report, every year, there are 3.3 million stillborns and four million newborns dying within
28 days after birth. Neonatal sepsis is identifi ed as the leading cause of neonatal deaths, along with pneumonia.

HIV mother to child transmission

Mother to child transmission (MCT) of HIV is another grave concern facing both mothers and newborns. Biologically, women are twice more than likely to be
infected with HIV. Their vulnerability is further heightened by the fact that in a male-dominated society, women often do not have bargaining powers, making them easy targets for violence and coercion.

In Asia, the prevalence of pregnant women with HIV is below fi ve percent, but given the fact that the continent is host to majority of the world’s population, the actual
number is still a cause for concern.

Half of MCT cases occur during delivery. This is a particular challenge in developing countries where majority of births are not attended by skilled personnel and the risk of infection is far higher.

Untying the knots

Like all other health issues, MCH also has a socio-political and economic dimension. Maternal and child deaths are preventable, but how come millions are dying? It is not a coincidence that developing and least developed countries also have the highest number of maternal and child mortality.

Poverty is the biggest stumbling block in the fi ght against maternal and child deaths. Malnutrition makes a pregnant woman and her children more prone to illnesses, but going to bed hungry is an all too common reality in poor regions.
Even access to education, which has been proven to have signifi cant impacts on maternal and child health, is a luxury for the world’s poor.

Developing nations rely mainly on foreign loans to prop up their economies. The social cost of such loans is steep: reduction in budget for key social services, including health. Thus, public hospitals and health institutions in developing nations are largely understaffed and lack equipment and supplies. Patients also have to pay for whatever services they are going to avail. In the Philippines, it is not unusual to see two mothers sharing a bed, or two newborns sharing a crib in government hospitals.

Under the current economic order, everything has a tag price – including health services. For millions of people struggling to eke out a living, paying for health services – no matter how badly needed – is simply not an option.

In an increasingly commercialized world, talks about equitable access to health care have been thrown out the window.

As governments renege on their responsibility to provide health care to their citizens, women and their children have been largely left on their own. And the results are disastrous. In the 2008 World Health Report, the World Health Organization is categorical in stating that globalization has “(put) the social cohesion of many countries under stress, and health systems, as key constituents of the architecture of contemporary societies, are clearly not performing as well as they could and as they should.”

Religion and cultural beliefs also play an integral part. Maternal and child health is an integral component of reproductive health (RH) and rights, but RH remains to be
a sensitive issue. Preventing unplanned pregnancy can reduce maternal deaths by one quarter, but a substantial number of women across the globe still has unmet needs
for family planning. In Asia, unmet needs for family planning range from a low of 7.6 percent in Iran, to a high of 30 percent in Thailand. The gap in the delivery of RH
information and services will have a particular resonance in light of the fact that more and more young girls are becoming pregnant; as well as the growing cases of
mother to child transmission of HIV.

Walk the talk

The needless deaths of millions of mothers and children bear down hard on the global community’s moral conscience and psyche. The reduction of maternal and child deaths is a tough task requiring not only medical interventions, but a holistic approach that would question the existing social inequities that make mothers and children at risk of dying.

Source: Health Alert Asia Pacific newsletter issue 15. To request copies of the newsletter, please write to hain@hain.org