The Lancet grabbed the attention of global health advocates this week when it published a study recording a significant drop in maternal mortality between 1980 and 2008. The global maternal mortality rate has declined approximately 1.3% per year, due to a combination of lower pregnancy rates, higher income, more education for women, and higher availability of skilled birth attendants.1 Though progress toward the fifth Millennium Development Goal varied significantly by country, the news is encouraging, particularly in a field where there has been a perception of no progress.
However, this positive finding also brings a new sense of urgency to countries where maternal mortality remains high. Yemen in particular has a depressing maternal and child health record. According to UNICEF, each Yemeni woman has 5.2 children on average, and the adjusted maternal mortality ratio was 430 per 100,000 live births. Only 47% of women were attended by skilled health personnel even once during pregnancy from 2003-2008 (only 11% were attended four times or more), and a mere 36% gave birth with a skilled attendant present.2 In 2005, 1 in 39 women died from childbirth or related complications. And yet maternal care is only one area where women suffer in Yemen: the country, which has attracted recent media attention for “child brides,”3,4,5 is ranked last in the World Economic Forum’s global gender gap index.3
In the face of such dismal statistics, one intervention, supported by the Extending Service Delivery project at Ibn Khaldoun Hospital in Lahej, is working to reduce maternal mortality. This intervention has greatly improved care given to mothers and newborns over the past year by implementing eight best obstetric practices:
- family planning counseling for women immediately after delivery
- Vitamin A provision to mothers after labor
- infection prevention controls
- kangaroo mother care for premature babies
- exclusive and immediate breastfeeding
- active management of the third stage of labor
- tetanus and polio vaccines for newborns
- newborn resuscitation
Through a partnering program, progressive religious leaders preach the merits of family planning in mosques and midwives meet with women’s groups to discuss contraceptive choices. Prior exposure to these issues then increases couples’ acceptance of the best practices when they arrive at the hospital. Dr. Jamila Raebi, Yemen’s deputy minister of health, is championing the program and has developed a plan to scale-up the practices to health facilities throughout the country.
The global-scale progress in maternal health currently being made highlights the need for progress in countries struggling with MDG5. Though these interventions have demonstrated promising results, all Yemeni women desperately need improvements to their country’s maternal health capabilities.