Episode 135 Embrace Equity
Florence: [00:00:00] Episode 1 35, embrace Equity. I'm recording this episode on International Women's Day 2023, and the theme, the hashtag that we've been invited to highlight today is Embrace equity. Hence the title of this episode in my attempt to embrace equity, I've decided today to talk a bit about global trends in maternal mortality.
I'm recording this episode because of a shocking headline that I saw on social media a week or two ago. The headline said a woman dies every two [00:01:00] minutes due to pregnancy or childbirth, and it was published by the UN Agencies and the W H O, the World Health Organization. It took my breath away. That means in an average episode of 30 minutes listening to this show, 15 women will have died somewhere in the world
that's an absolutely shocking statistic. In some ways, it's not surprising. I'm aware that I'm very fortunate. I practice in a country where the maternal mortality is comparatively very low. Our rate is around nine or 10 women per hundred thousand.
but I know that this is not the case [00:02:00] in many other countries with less fortunate circumstances or less equitable healthcare system. So I decided to delve into the report in a bit more depth. , what's the information that lies behind that dramatic headline of a woman dying every two minutes due to pregnancy or childbirth globally?
And to give you some personal reflections as well as my kind of key points from the data, that statistic equates to the fact that 287,000 deaths occurred in a year. That's over a quarter of a million women dying every year from pregnancy or childbirth. [00:03:00] Where do these statistics come from? The headline was essentially related to the publication of a report that looked at trends in maternal mortality from 2000.
To 2020. This was a joint estimate by the W H O World Health Organization, UNICEF UN F P A World Bank, and the U N D E S A population division. So one can hardly argue with the quality or the objectivity. Of the data, if you read the press release relating to the data, it talks about the fact that there have been alarming setbacks for women's health in recent [00:04:00] years as maternal deaths either increased or stagnated in nearly all regions of the world.
The report discusses the sustainable development goals devised in 2015, the sustainable development goal relating to maternal deaths aimed to reduce maternal mortality worldwide to less than 70 maternal deaths per hundred thousand live births by 2030. Alongside this sustainable development goal is the ambition that no
country or region's maternal mortality rate should exceed 140 deaths per a hundred thousand live births. i.e. No country should [00:05:00] exceed more than twice the goal of 70 per hundred thousand. And as I mentioned, these goals were devised in 2015 and the aim is to achieve them by 2030, and here we sit in 2023 and we are far from there.
These goals were then broken down so that any country that already had a maternal mortality ratio, greater than 420 per hundred thousand were given that second target of a maternal mortality ratio of 140 or less by 2030. And if they were already less than 420, their target was to reduce maternal mortality by at least two thirds by 2030.
countries with maternal mortality ratios [00:06:00] already below the 70 by hundred thousand. Were also called upon to achieve equity in maternal mortality ratios across different population groups within each country, so that although our maternal mortality ratios are lower, We can't rest on our laurels because we know there is inequity across our population with certain groups, particularly from ethnic minorities having much higher rates of maternal mortality, which is unacceptable.
If you've listened to my previous episode on statistics, you'll know that one of the key important things when comparing outcomes between different countries is case ascertainment and definition. And the report very clearly lays out definitions for, for maternal death, what is considered directly related to pregnancy, [00:07:00] what is considered indirectly related, and also.
what is incidental and the timing of these deaths. I'm not a statistician, but a significant amount of the methodology is dedicated to discussing case ascertainment, and there's also significant amount of discussion about the level of uncertainty the estimation and use of the amount and quality of available data in some of the different countries.
We are very fortunate. We monitor our maternal deaths very closely and have done for more than 50 years, but other countries are not there. They may be monitoring maternal deaths but actually in some cases there may be no overall [00:08:00] monitoring of maternal deaths at all. So the report clearly lays out how likely it is that these estimates are correct.
There's a very detailed table box 4.1, which helped me as a person who's not terribly capable with data and what it said is that there's an 80% chance that the true 2020 global maternal mortality rate lies between 202 and 255 per hundred thousand. It then goes on to say that they're 90% certain that the true 2020 global maternal mortality rate is at least 202
okay, let's take that in context. Remember I said [00:09:00] that the sustainable development goal is for countries to have a maternal mortality rate of 70 per hundred thousand, and for the worst countries to have one of 140 per hundred thousand. Even if these estimates are inaccurate, we are a long, long way from achieving that sustainable development goal that we're hoping to in seven years time.
There's also the staggering statistic about the difference between regions detailed in the report with more than 70% of maternal deaths taking place in Sub-Saharan Africa.
giving a lifetime risk of maternal death of one in 40 in comparison with a lifetime risk [00:10:00] in Australia, for example, with a very low maternal mortality rate of one in 16,000. But those of us that think we are working in more developed countries and that we've got this nailed, cannot be complacent. If you look back at the press release, two of the eight UN regions show an increase in maternal mortality from 2016 to 2020.
The top one being Europe and North America, A rise of 17%. and the second one being Latin America and the Caribbean arise of 15%. Some other regions such as Australia and New Zealand and Central and Southern Asia experience significant declines. So it is [00:11:00] possible to make a difference. Okay, so this is a massive problem, but what do I think we can do about.
Well, the tragic thing is that when you look at the report and the W H O press release, it talks about the fact that many of these deaths were related to severe bleeding, high blood pressure, pregnancy related infections, complications from unsafe abortion, and underlying conditions aggravated by pregnancy
therefore, these are all largely preventable and treatable with access to high quality, respectful healthcare. It talks about the importance of antenatal care as well as postnatal care and access to modern family [00:12:00] planning. It talks about 270 million women lacking access to modern family planning, which takes me back to the podcast episode I recorded with Dr.
Benjamin Black about his experiences during the Ebola epidemic and the importance of reproductive healthcare and contraception. as part of humanitarian medical efforts. So we have massive inequity with different women in different countries being unable to access basic antenatal care, family planning, and postnatal care inequality due to region income.
Education and race the W [00:13:00] H O write that reducing maternal mortality remains one of the most pressing global health challenges, and that if we don't significantly accelerate progress to meet that sustainable development target, that global goal for reducing maternal. We are risking the lives of over 1 million more women by 2030 1 million women!
And let's not forget women of reproductive age. These are young women. These are women. Any time from the menarche to the menopause. So they're probably going to be somewhere between 15 and 50 years of age. , these are not old women. And not only is a woman dying in pregnancy [00:14:00] or as a new mother, a horrendous thought in itself, it has a ripple out on her, perhaps existing children, extended family, or local community
again. When I talked to Dr. Benjamin Black, he spoke about talking to women in Sierra Leone and explaining to members of the community that it was not normal for women. Their sisters, their mothers. their cousins to die during pregnancy or birth. So what's my zesty bit . I can't possibly hope to provide equity in healthcare to women across the globe, but I can, by speaking up and drawing attention to that [00:15:00] headline of a woman dying every two minutes, try and keep the conversation alive.
I can as an maternity worker, be an advocate. , we need to speak up. We need to make noise. We need to make sure that this is unacceptable, so that the world starts to accept that this is the global health crisis that the W H O discuss. . The report also details the fragility of healthcare systems, and you only have to turn to the news to see the impact of conflict in Ukraine, earthquake in Syria.
How precarious delivery of [00:16:00] healthcare to women in those circumstances can be . Surely as a global society, we need to stand up and clamor for women's health during pregnancy, birth, and reproductive years to become a greater priority, embrace equity. So for my zesty bit, please share this episode. Make sure everyone is having the conversation and do what little you can to make sure that women's voices are heard.