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Maternal health

Since 1990, and until the millenium development goals (MDGs) were estimated in 2015, the world has seen a 44 per cent decline in the maternal mortality ratio – an enormous achievement. But in spite of these gains, more than 800 women still die every day from causes related to pregnancy or childbirth, around ⅔ of them in humanitarian and fragile contexts. This translates to one woman dying every two minutes mostly from preventable causes. And for every woman who dies, much more survive with serious or long-lasting consequences that are also entirely preventable.

Making motherhood safer is a human rights imperative, and it is at the core of UNFPA’s mandate. To achieve its first transformative “ending preventable maternal deaths”, UNFPA works around the world with governments, health experts and civil society to train relevant cadres of health workers, improve the availability of essential medicines and reproductive health services, strengthen health systems, and promote international maternal health standards. 

In the Arab region, UNFPA works directly with national counterparts to improve maternity care programming and policy development, and implementation; and health system strengthening. Not only direct country support, but also through regional partnerships and intergovernmental bodies such as the League of Arab States (LAS), the Organization of Islamic Cooperation (OIC) and the African Union Commission (AUC). 

In 2019, UNFPA supported the League of Arab States to develop their 11-year regional strategy on Maternal, Child and Adolescent Health (2019-2030), to ensure that no woman has to die while giving birth.

Significant strides, but not enough

Most maternal deaths are preventable. As per the 2019 State of the World Population report,  an estimated 215,000 women died of causes related to pregnancy or childbirth. A majority of them died from severe bleeding, sepsis, eclampsia and obstructed labour. – all causes for which there are highly effective interventions. And the tragedy does not stop there: When mothers die, their families are much more vulnerable, and their infants are more likely to die before reaching their second birthday.

But significant reductions in maternal mortality are possible, and they are taking place. The maternal mortality ratio in the Arab states region has fallen from 285 maternal deaths per 100,000 live births in 1990 to 162 deaths per 100,000 live births in the span of two decades. 

In many Arab countries – including Egypt, Morocco, Oman, and Tunisia – maternal deaths have fallen as women have gained access to family planning and skilled birth attendance with backup emergency obstetric care.

But much more still needs to be done. Unacceptably high ratios of maternal mortality do exist, particularly in impoverished communities. Working for the survival of mothers is a human rights imperative, and it is a development priority. The International Conference on Population and Development and the Sustainable Development Goals, call for bringing the global maternal mortality ratio down to 70 deaths per 100,000 live births by 2030. 

The best way to achieve this ambitious target is to: ensure all women have access to contraception to avoid unintended pregnancies; provide all pregnant women with skilled and respectful care in a safe environment during delivery; and make sure women with complications have timely access to quality emergency obstetric care in line with the UNFPA transformative results that aims at achieving zero preventable maternal deaths and zero unmet need for family planning.

Complications of pregnancy or childbirth

For every woman who dies from causes related to pregnancy, much more survive with serious complications, for example obstetric fistula. Women who survive such complications often require lengthy recovery times and may face lasting physical, psychological, social and economic consequences. Although many of these complications are unpredictable, almost all are treatable.

Without treatment, these conditions can kill, disable or lead to stillbirths. The costs of medical care and lost productivity can also drive women and their families into poverty. Obstetric fistula, for example, can result in chronic infections, social isolation and deepening poverty.

Antenatal care

Prenatal care is an important part of basic maternal health care. It is recommended expectant mothers receive eight antenatal care visits, in which a qualified health worker can check for signs of ill health – such as underweight, anaemia or infection – and monitor the health of both the mother and the fetus. During these visits, women are counselled on nutrition and hygiene to improve their health prior to, and following, delivery. They can also develop a birthing plan laying out how to reach care and what to do in case of an emergency, in addition to counseling on postpartum family planning options.

Because these visits may be a woman’s first interaction with the health system, they are an important opportunity to assess her overall health, and to speak with her about her sexual and reproductive health and rights. In these settings, women learn the health benefits of spacing births and how to plan their families. They are also counselled on newborn care and the importance of birth registration.

Still, the great majority of complications arise with little or no warning among women who have no risk factors. While antenatal visits may not prevent complications, women who receive antenatal care are more likely to deliver with the help of a skilled birth attendant, who can recognize and address these issues.

Skilled birth attendance

 Skilled attendance at birth, with emergency backup, is considered the most critical intervention for ensuring safe motherhood. Skilled birth attendants are health workers, such as doctors, nurses or midwives, who have the skills to manage normal deliveries and recognize the onset of complications. They perform essential interventions, start treatment, and supervise the referral of complications to emergency care. Skilled attendance is also vital for protecting the health of newborns, as the majority of perinatal deaths occur during delivery or in the 48 hours afterward.

Skilled attendance requires an enabling environment, such as a clean delivery area with the necessary supplies and equipment. And skilled birth attendants must provide respectful care that takes into account the dignity of the pregnant woman. Unfortunately, many countries have severe shortages of trained health providers with midwifery skills.

Emergency obstetric care

Emergency obstetric care is critical to reducing maternal mortality. All major direct causes of maternal death – haemorrhage, sepsis, hypertensive disorders and obstructed labour – can be treated at a well-staffed, well-equipped health facility. In such settings, many newborns with asphyxia or infection can also be saved.

In case of complications, all women and newborns should have rapid access to well-functioning emergency obstetric care facilities meeting good quality-of-care standards. And in the long term, all births should take place in appropriate facilities, as is the case in all countries that have managed to significantly reduce their maternal mortality.

Postnatal care

Postnatal care starts within the first 24 hours of delivery. Bleeding, sepsis and hypertensive disorders can all take place after a woman has exited the health centre. And newborns are also extremely vulnerable in the immediate aftermath of birth.

UNFPA strongly recommends follow-up visits by a health worker to assess the health of both mother and child in the postnatal period.

UNFPA at work

Making motherhood safer is a top priority for UNFPA. UNFPA works at all levels to promote universal access to sexual and reproductive health care and rights, including by promoting international maternal health standards and providing guidance and support to health systems.

At the Arab states region, UNFPA-supported programmes emphasize capacity development in maternal care and midwifery, especially the strengthening of human resources and emergency obstetric and newborn care. Among its many programmes, UNFPA helps to train midwives, supports emergency obstetric and newborn care facilities and networks, and provides essential drugs and family planning services. UNFPA also supports the implementation of maternal death review and response systems, which help officials understand how many women are dying, why, and how to respond, ensuring the integration of evidence generated from robust studies into policies and systems development. In 2017/18, UNFPA led a multi-country assessment of Maternal Death Surveillance and Response systems in the region and disseminated the generated evidence to all Arab countries. The objective is to inform national policies and programs and build a human rights based approach that integrates both quality and accountability dimensions 

Recognizing that maternal mortality and morbidity remains especially high in poor, fragile and humanitarian affected countries, where more than a third of global maternal deaths occur, UNFPA in the Arab region additionally seeks to make pregnancy and childbirth as safe as possible in these settings. A key contribution to improving the situation of maternal health in the region is to ensure the implementation of the Minimum Initial service Package of SRH in crisis affected countries and the integrated approach to addressing obstetric fistula in the region in the countries where it is most reported such as Djibouti, Somalia, Sudan and Yemen.