BRIDGE Report 38: Challenges to women's reproductive health: maternal mortality

Author: Z. Oxaal, S. Baden
Publisher: BRIDGE
Publication Date: Jan 1996
Why, despite continual technological and medical advance, do one out of every fifty women in developing countries still die in pregnancy and childbirth' This paper explains how socio-economic, cultural and political factors make women vulnerable to maternal death. It also explores their capacity to access maternal health services and gender biases within these services. Women's domination by men and their inferior status in society has many implications for maternal mortality, including lack of control in sexual relations and decisions about their own health, lack of access to education, and being subject to men's physical and economic control. Health spending must deliver more quality care to women, and policy must be shifted towards overcoming women's lack of physical, sexual, economic, social, and political autonomy. A variety of long and short-term strategies must be pursued to both directly and indirectly promote safe motherhood, such as guaranteeing women access to family planning and health services, improving women's educational attainment, self confidence, and decision-making capacities.

Scientific understanding of medical conditions that lead to maternal death and complications in pregnancy is well established. However, underlying social issues and gender biases that place so many women at risk have not been widely recognised or incorporated into health care programmes. Moreover, only a small percentage of health budgets are allocated to maternal and child health care, and the majority of this inadequate amount is spent on child health and family planning, instead of maternal care. The following factors affecting maternal mortality rates must be recognised: . Women's lack of control of their sexuality coupled with society pressures to have many children (particularly sons) can often result in multiple pregnancies. The more children a woman has, the higher her risk of death. . Women often lack decision- making power to seek medical services (men might discourage them from doing so), and may be hesitant to seek care if they do not value their health, or if they have been physically abused. . Violence against women, particularly female genital mutilation, heightens risk of complications and/or mortality during pregnancy and delivery. . Women are in great lack of accessible quality care in some countries. Where services exist, quality is often extremely poor, culturally insensitive, and does not favour women's needs. . Large distances and poor rural transport, sometimes accompanied with social restrictions on movement, severely limit women's access to health services, especially emergency obstetric care. . Women's heavy workloads negatively impact upon their ability to rest before and after delivery, nutritional status during pregnancy, and attendance for antenatal care. . Women's higher level of education and access to income can decrease fertility and their risks of maternal mortality. . Access to safe and legal abortions and birth control can significantly decrease fertility and maternal mortality. Interventions and policy recommendations include: . Consider insurance and other financing options to enable households to make direct financial contributions to cover costs of maternal care in advance and avoid struggles to urgently cover these at times of need. . Train health workers on necessary skills for responding to violence, rape, and abuse experienced by patients. . Increase the number and geographical distribution of maternity waiting homes, where women can stay prior to giving birth (if culturally appropriate and distance prohibits women from seeking timely medical attention). . Strengthen women's organisations and their involvement in safe motherhood initiatives, in order to raise women's awareness and pressure medical services to respond to the needs and perceptions of users. . Target and involve men in maternal health education and awareness, including drawing attention to women's heavy workloads in pregnancy. . Review legislation relating to abortion, contraception and medical consent to guarantee women's right to make decisions about their own reproductive health. . Develop capacity for gender analysis and planning in health ministries and increase public dialogue on reproductive health at the macro level. . Research cultural perceptions of appropriate maternal services, health- seeking behaviour and linkages to sexuality, using participatory approaches. . Pursue long-term strategies such as increasing women's level of education and improving rural infrastructure to improve women's access to medical services.