Posted on Sep 26, 2008 by Sergio Ulloa
As the U.N. General Assembly gets started this month, one cause in particular seems to be under the spotlight; staggering global maternal mortality rates that have gone seemingly unnoticed, until now.Since the WHO's Commission of Social Determinants of Health presented their results
on the social factors of global healthcare inequity in August, a growing number of voices have brought maternal mortality rates to the center of attention. Both the UN's funds for children, UNICEF, and women, UNIFEM, have released reports on maternal healthcare
barely a week before the General Assembly is set to have a special meeting regarding U.N. Millennium Development Goals. Others have also called for greater support of the goals including Oxfam and various political figures, with one European Member of Parliament calling for more "political will
" to deal with the problem.
Just in case you're wondering, Millennium Development Goal (MDG) number 5
is to improve maternal health by 2015, aiming to reduce the maternal mortality ratio by three quarters and to make universal access to reproductive care possible. One would think this quite a lofty goal, everything considered, or is it?
Alongside the reports' and news stories' depictions of broken systems, horror stories and exhortations to action, there was also a measured amount of good news, and some of it coming from completely unexpected places. Africa and Southeast Asia, unsurprisingly, still labor under some of the worse mortality rates and accessibility to reproductive care, but, there are vast disparities between countries in the two areas.
Take Sri Lanka, where the maternal mortality rate has dropped from 155 deaths per 1,000 live births to only 1.4 per 1,000 in the last 60 years or so
. Due to the government's determination to achieve the MDGs, they now have a strong healthcare system where any individual Sri Lankan has access to primary care within 5 km
and 97% of all births in the country are attended by a skilled professional
, typically one of the Public Health Midwives
. This stands in stark contrast with other nations in the vicinity. For example, in India only 41% of births are delivered by a professional and in 2005 an estimated 117,000 maternal deaths in India made up around 22% of the world wide total
Africa is much the same story, some countries like the 6 nations in the Gulf Cooperation Council, Syria and Jordan which have professional care during birth at least 90% of the time
(100% in Jordan according to the figures), while, on the flip side, Sudan and Yemen have maternal mortality ratios that at least double the regional average of 210
, triple that in Djibouti, and an astounding rate of 2,037 deaths per 100,000 births in Southern Sudan
where maternal healthcare is almost non-existent due to ongoing conflict.
One of the oddest things about the stories in recent articles is that it seems that the maternal health situation of the country has little or nothing to do with the economic prosperity of the nation. Case in point, despite being from a much richer country, South African women are 3 times more likely to die giving birth than Cuban women.
So if it isn't an issue of economic inequity between countries (if you needed more proof of this, the United States of America has a higher infant mortality rate than Cuba
) what is it?
Judging by the relative success stories of Sri Lanka, Cuba and the like, accessibility of care and trained professionals are the ground work for a sturdy system. Oxfam, which has recently been training midwives in Northern Africa, has made some recommendations based upon their work experiences and WHO data
. It pretty much mirrors the advice given in the Commission of Social Determinants of Health study, in that you need to need to have trained professionals who are readily accessible and affordable if you really want to bring down maternal mortality rates, or any other mortality rates really. Considering that most people across the world go through public health systems for child birth
, and that national governments would be in the best position to assess, roll out, and fund such a reformative healthcare system, it really only makes sense to pour our efforts and funding into public systems.
So what repercussions does this snowballing notion of affordable, basic healthcare have for the insurance world? Short-term, barring a critical mass of governments deciding to pick up this challenge, there is probably not going to be any change in your insurance premiums, and healthcare in various parts of the world will probably cost the same. However, long-term, I hope this has far reaching implications. If every mother in Southeast Asia or Africa had access to cheap professional maternal care, pregnancy would become a time for celebration instead of worry, both infant and maternal mortality rates would drop and communities would be richer for it. A world in which quality basic healthcare is available to just about anyone at affordable prices, regardless of location, would be a fundamentally different one. For one, if the affordability and accessibility of healthcare was a primary focus, for-profit healthcare systems may be difficult to maintain, which, in itself would have enormous ramifications for the insurance industry.
Either way, unless governments can find enough backbone to drastically alter the current global healthcare situation, poorly organized, under-funded, inaccessible and unaffordable healthcare will continue to be the death of people all over the world.