Maternal health is a term used to refer to the health of a woman during pregnancy, childbirth, and the postpartum period – which can last up to 6 months after the birth of the baby. This is not to be confused with the perinatal period, which lasts from 22 weeks gestation until 7 days after childbirth.
The overall health of the mother leading up to and during pregnancy can have a profound effect on the pregnancy itself, but also on the newborn infant’s health and development into childhood, adolescence and adulthood. Lifestyle factors including a healthy diet, physical activity levels, whether the mother is a smoker, using illicit drugs, and levels of alcohol consumption can all play a pivotal role in determining the likelihood of the newborn developing chronic conditions later in life.
It is known that there are certain factors that correlate with lower maternal health, such as socioeconomic status (poverty has been repeatedly linked with lower reproductive health), adequate access and uptake of maternal health facilities, and particularly, antenatal care (ANC). In 2016, the WHO developed guidelines for ANC – which serves as a platform to facilitate more positive pregnancy experiences, providing early management and intervention when things go wrong, and eventually saving lives.
To understand that maternal health is an indicator of global development and public health is to understand that we are only as good as our weakest link. In other words, whatever access to maternal healthcare our most under-resourced communities have, indicates how successful we are at ensuring maternal health for all. Making improvements in the most resource-poor areas would lead to huge gains on global averages.
Women in remote areas with limited finances are the least likely to receive the necessary healthcare when pregnant and in the following weeks and months. This is particularly the case for remote regions when there is also a shortage of skilled health workers.
For example, most high- and upper-middle-income countries benefit from having a trained midwife, nurse, or doctor present at 90% of all births. By contrast, less than half of all births in low- and lower-middle-income countries receive the same kind of medical support.
Some of the factors preventing women from seeking or receiving adequate care during pregnancy and childbirth include, but are by no means limited to:
- Poverty
- Distance to facilities
- Lack of information
- Inadequate and poor quality services
- Cultural beliefs and practices
Barriers that limit access to quality maternal health services must be identified, addressed, and alleviated at both the levels of the health system and society.
However, it is important to note that even within high-income countries, great disparities exist in maternal health. Between 2011 and 2014, the maternal mortality rate among Black American women was 40 in 100,000 live births, compared to just 12 in 100,000 for white American women.
In fact, the disparity in health outcomes for different groups is so stark, that in 2008, human rights groups around the world began calling on the U.S. to do more to keep its mothers from dying. The US government was again called out in 2012, this time by Amnesty International, for not taking the necessary steps to curtail this inequality.
This shows just how systemic and entrenched maternal health is with wider social norms and the behavior of the people who operate within the nation. Black women are more likely to be dismissed by doctors, have their symptoms belittled, or be refused pain medication (or at least be given a weaker dose).
So where does this leave us? It seems clear that the only meaningful way to drastically reduce maternal mortality is to address the structural factors at play around accessing adequate medical care. Indeed, this is exactly what a 2015 study found.
Published in the journal of Global Health, it concludes, “…decreasing maternal mortality requires dealing with various factors other than individual determinants including political will, reallocation of national resources (especially health resources) in the governmental sector, education, attention to the expansion of the private sector trade and improving spectrums of governance. In other words, sustainable reduction in maternal mortality (as a development indicator) will depend on long-term planning for multi-faceted development. Moreover, trade, debt, political stability, and strength of legal rights can be affected by elements outside the borders of countries and global determinants.”
Summing up, maternal health is an incredibly important marker of a country’s public health system. More important than its role as a global development indicator is the impact positive maternal health has on societies. Physically and psychologically healthier children, more economically prosperous people, and happier livelihoods.
Disparities in maternal health are seen between more and less well-resourced countries, but also within single countries – for example between white and Black women in the United States. This points to the need for a long-term, top-down approach to tackling inequalities in pre- and post-natal care. Recent developments of technology have allowed progress to permeate even the most remote regions, and if we keep up this trend, we will continue to decrease maternal mortality across the world and provide better healthcare for women everywhere.
