Women Deliver brings together voices from around the world to call for action to improve the health and well-being of girls and women, and the latest issue of The Lancet highlights some of the latest research and views on maternal health.
- Grassroots women's groups could halve maternal death rate
- Analysis of official development assistance for reproductive health finds that less than a tenth of funding is directed towards family planning
- Death rate in HIV infected pregnant women eight times higher than for non-HIV infected
- Need to go beyond "essential interventions" for reducing maternal deaths highlighted in study of 29 countries
- 1 in 4 women in developing countries who wish to avoid pregnancy have unmet need for modern contraception
- Gender 'missing and misunderstood' in global health
Grassroots women's groups could halve maternal death rate
Women's groups can dramatically reduce the number of maternal and newborn deaths in some of the world's poorest communities, according to a new meta-analysis of seven trials in Bangladesh, India, Malawi and Nepal. The studies analysed assessed whether groups facilitated by local women, who received a short training course of around 7 – 11 days, but were not health workers, affected rates of maternal and newborn mortality. The groups use a range of methods – including discussion, voting, role-playing – to identify common pregnancy-related health problems, and then work out ways to address these problems which are locally relevant.
Overall, in areas where groups were established, maternal deaths in the population as a whole fell by 37%, and newborn deaths fell by 23%. The reductions in maternal and newborn deaths were even more dramatic in areas where more than a third of women took part in the groups, with maternal deaths falling by 55%, and newborn deaths falling by 33% in these areas. The authors point out that the groups are cost-effective, sustainable, and may be one of the most powerful ways to reduce maternal and newborn deaths in areas where other interventions are impractical or unaffordable. One of the studies included in the meta-analysis – a study on women's groups in Malawi, one of the first trials of this type in an African country – is published at the same time.
Analysis of official development assistance for reproductive health finds that less than a tenth of funding is directed towards family planning
A new analysis of official development assistance (ODA) for reproductive health in 2009 and 2010 finds that less than a tenth (7%) of the total funding was spent on family planning. Around half of the total funding was spent on the prevention, care, and treatment of HIV infection for adult women. The study is the first to look at how aid is disbursed for a comprehensive set of reproductive health activities, including treatment of sexually transmitted infections The authors found that aid was heavily dependent on just five main donors: USA, UK, the Global Fund, United Nations Population Fund, and the World Bank, who together provided around three quarters of the total funding for reproductive health. The top recipients of aid are heavily determined by funding to HIV activities. Overall, the analysis shows that aid appears to be largely directed to the countries that need it most, though information on domestic resources to reproductive health is still lacking and further data is needed on aid from non-profit organisations, private foundations (in addition to the Gates Foundation), and emerging donors such as China.
Death rate in HIV infected pregnant women eight times higher than for non-HIV infected
HIV-infected pregnant or post-partum women are eight times more likely to die than their non-HIV infected counterparts, suggesting that around a quarter of deaths in pregnancy in sub-Saharan Africa may be attributable to HIV. While it has previously been suggested that increasing rates of maternal mortality in some sub-Saharan African countries are due to the effect of HIV, until now there has been little evidence for this: previous estimates, based on mathematical models, have shown wide variation. The new study is the first empirical study to estimate the effect of HIV, and was based on data from six independently established community based studies in Malawi, Zimbabwe, Uganda, Tanzania, and South Africa. The authors suggest that the high proportion of deaths in pregnant women with HIV may partly result from the way pregnant women have been treated for HIV in some areas; drugs were generally given to prevent mother-to-child transmission, usually made available just before delivery, when it is too late to help the mother's survival. The authors call for HIV and reproductive health services to be integrated with safe motherhood programmes, so that pregnant women who are infected with HIV can be can be actively encouraged to take up HIV treatment during their pregnancy.
Need to go beyond "essential interventions" for reducing maternal deaths highlighted in study of 29 countries
The largest study to date assessing severe complications and 'near misses' in pregnancy has found that 'essential interventions' – simple treatments which are indispensable for effective maternal care, such as providing uterotonics for preventing postpartum haemorrhage, or magnesium sulphate for eclampsia – do not necessarily reduce maternal mortality in health care facilities which provide them. The study examined data from more than 300 000 women attending health care facilities in 29 countries, assessing how many pregnant women had a severe maternal outcome (defined as either maternal death or a near miss), as well as the coverage of essential interventions in the health care facilities studied. The most frequent complications were post-partum haemorrhage and pre-eclampsia / eclampsia, and women with severe maternal outcomes were usually older than 35, with less than five years' education, and had already had at least one child. The authors suggest that if substantial reductions in maternal mortality are to be achieved, universal coverage of essential interventions will not be enough, and needs to be matched with comprehensive emergency care and overall improvements in the quality of maternal health care.
1 in 4 women in developing countries who wish to avoid pregnancy have unmet need for modern contraception
A new analysis of the unmet need for contraception in the developing world finds that women in the poorest countries are three times more likely to have an unmet need for modern contraception than their counterparts in higher-income developing countries. The study, which is unique in including estimates for all developing countries and for both married and unmarried women, found that use of modern contraceptive methods increased from 506 to 645 million couples in developing countries between 2003 and 2012. However, most of this increase just kept up with growing demand.
Although the proportion with unmet need for contraception declined slightly over these years, the absolute numbers of women requiring modern contraception rose, mainly due to population growth. Currently, 222 million women in the developing world want to avoid pregnancy, but are not using any contraception or using a traditional method, which have high failure rates than modern contraceptives. Four in 10 women in the lowest-income countries who wish to avoid pregnancy have unmet need for modern contraception, with the proportion as high as 60% in sub-Saharan Africa.
The authors note that among those using modern contraceptives, there has been a shift away from sterilisation, towards barrier methods and injectables, both of which have higher failure rates than sterilisation. They argue that this trend calls for greater focus on services that support women in using contraceptive methods consistently and correctly, by providing adequate follow-up care, increasing public education, and addressing young peoples' needs for quality information and services.
Gender 'missing and misunderstood' in global health
Global health organisations are failing to implement truly gender-equitable policies in their work, and by doing so, risk unwittingly enforcing gender inequities, say the authors of a Viewpoint published as part of The Lancet's Women Deliver special issue. The authors point out that globally, men have a higher burden of disease and lower life expectancy than women, yet there are very few global health policies or programmes specifically focused on male health.
The authors argue that although women are globally at social, economic, and political disadvantage, and that women-centred health services are critical to improving global health, a failure in health policy to reflect gender in a truly equitable way means that in some areas, men are being ignored in global health policies and programmes. They conclude that this unwittingly reinforces gender inequalities in health.
Furthermore, incorporating gender equitable policies into all development activities could help us better understand better some of the aspects of health which disproportionately affect men, such as tobacco and alcohol use, or road safety. According to the authors, gender norms affect everybody's health, and a proper focus on gender equality by the global health community will be vital if we are truly to achieve 'health for all'.
Journal
The Lancet