Need to improve maternal health

Objective: Reduce the maternal mortality ratio by three-quarters by 2015. According to the World Health Organisation, about 16 million women between the ages of 15 and 19 years give birth each year, accounting for 11 per cent of all births worldwide. The majority of these births occur in middle to lower income countries with the average adolescent birth rate in middle-income countries being twice as high as that of high-income countries. Among lower-income countries, this number is five times as high.

In Malta, six per cent of births in 2007 were to mothers under the age of 20. Throughout the rest of the globe, the number of young women who give birth before the age of 18 varies dramatically. Yet, according to the Save the Children Organisation, sub-Saharan Africa has the highest rate of teenage pregnancy in the world where child marriage is common. Research conducted in Niger indicated that 87 per cent of young women surveyed were married. Of those women, 53 per cent had given birth to a child before the age of 18.

Other indicators of adolescent pregnancy include lack of or inaccessibility to education and sexual health care services as well as sexual coercion. Births to unmarried adolescent mothers are more likely to be unintended and unwanted.

In September 2000, a directive from the United Nations saw the birth of a global partnership commitment aimed at significantly reducing extreme poverty before the year 2015 by outlining a series of time-bound targets now referred to as the Millennium Development Goals. Since January , SOS Malta, along with other members of the EU Community, has made a commitment to address Millennium Development Goal #5 - maternal health. Save Women's Lives is an EU-funded campaign project aimed at raising public awareness on maternal health.

There are many socio-economic reasons to reduce the occurrence of adolescent pregnancy throughout the developed and developing world, yet, as a starting point, particular attention needs to be focused on the high rate of maternal mortality among many child-bearing women.

Every year, over one million children are left motherless and vulnerable as a result of maternal mortality. Numbers indicate that every minute a woman dies of pregnancy and childbirth complications. This adds up to 500,000 women annually and 10 million over a generation. Ninety-nine per cent of these deaths occur in the developing world. In sub-Saharan Africa, a woman's risk of dying from treatable and preventable complications of pregnancy and childbirth is one in 22. Compare this to one in 7,300 in the developed world.

In the past, focus from a health perspective has been on child survival. While this is indeed important in itself, child survival is also dependent on the health of the mother. More than 80 per cent of worldwide maternal deaths have been a direct result of five common causes: haemorrhage, sepsis, unsafe abortion, obstructed labour and hypertensive disease.

Specific dangers arising out of adolescent pregnancies include anaemia, malaria, HIV and other sexually-transmitted infections, postpartum haemorrhage and mental disorders such as depression. Sixty-five per cent of women with obstetric fistula develop this as adolescents, with negative consequences for their lives, both physically and socially.

Adolescent pregnancies also increase risks to the children they carry. Stillbirths and death in the first week of life are 50 per cent higher among babies born to mothers younger than 20 years than among babies born to mothers aged 20-29 years old. The rates of pre-term birth, low birth rate and asphyxia are higher among children born to adolescents, all of which increase the chance of death and future health problems for the baby. Pregnant adolescents are also more likely to smoke and use alcohol than older women, which can cause serious problems to children after birth. What needs to be done?

Policy changes and sufficient funding at the national and international level are key to reducing maternal death globally. A reallocation of resources and a strengthening of health care programmes around the world can help make reproductive care services more universally accessible to all women. Pregnant women need access to trained health care workers, during and following pregnancy, especially those women in rural areas of the developing world, where there is little or no guidance and care.

Education needs to be enhanced, with focus on general sexual health and maternal health to teach young men and women how to prevent unwanted pregnancies and reduce the spread of HIV and other sexually-transmitted diseases. Adolescents, both male and female, should be encouraged to remain in school, increasing their economic prospects and reducing their dependency on their families and the state.

Most significantly, women need to be encouraged to empower themselves, to seek support from their community, both at home and at a global level.

For more information on Millennium Development Goal #5 and the Save Women's Lives Campaign visit SOS Malta at www.sosmalta.org.

The author is a staff member of SOS Malta.