Unfortunately, the birthing bed is not only a place for new life – death has always been close by as well. In many places in the world, the risk of giving birth is still far too high: It is estimated that 287,000 women died in connection with pregnancy and childbirth worldwide in 2020. But the latest figures from the World Health Organization WHO, the UN and the World Bank show that maternal mortality globally has fell by more than a third between 2000 and 2020. There are more educated health personnel and it saves hundreds of lives every single day. It is a big step forward for women’s health – but at the same time the good development is flattening out. Both the corona pandemic and changing political focus mean that work on the health of mothers is under pressure. The experts say that the efforts for women’s health and investments require a renewed focus – because we know very well what works to save the lives of women giving birth. More personnel Merete Engell has been on the front line for women’s health for more than 20 years. She is a nurse with Doctors Without Borders and has been deployed to many of the African countries where maternal mortality is still the highest. She has also worked in disaster areas – such as landslide-stricken Haiti or war-torn Afghanistan – where a birth can be extra critical. She has just returned home from Mosul in Iraq, where she trained health personnel. – Regardless of whether there is war or not, women must still give birth, says Merete Engell. As part of MSF’s emergency team, she was used to going out to the places where the situation was worst. Nevertheless, she has seen a development where Doctors Without Borders works. – There have been bigger hospitals, better facilities and more educated staff, she says. In the past, we often simply stood and patched people together under a tree. So it is clearly progress. At the same time, MSF has worked to create a more established network between the larger hospitals and the smaller health clinics in order to get them up and running. – That way it has become more of a system, the health clinics can refer the cases that need more help to us, and have the patients sent to us, she says. Many people in poor countries may otherwise experience having to walk for hours to receive treatment. – But we have worked a lot to ensure that it is possible to refer when there is a need for it, that there are ambulances for transport and that there are trained staff who receive them when they arrive, explains Merete Engell. It is vitally important that there are well-educated staff for births and worldwide, the proportion of births with trained healthcare personnel rose from 63 per cent in 2000 to 83 per cent in 2019, figures from the World Bank show. Long way to go The biggest falls in maternal mortality have occurred in South and Central Asia, where the proportion has fallen by two-thirds between 2000 and 2020. The worst affected areas are in Africa, where West, Central and East Africa still have high death rates. Of the 13 countries with the highest maternal mortality, Afghanistan is the only non-African country. But there is progress in all regions of the world. Still, there is no time to rest. The greatest progress in the period occurred between 2000 and 2015, and since then the development has leveled off, WHO data shows. – This is partly due to corona, says Merete Engell. Put simply, the health systems had to spend effort and money on getting large sections of the population vaccinated at the expense of their normal work. – The fight against the pandemic took resources from other agencies. In addition, closures made it more difficult for pregnant women to get to hospital. But beyond that, there are also changing political priorities. For example, the USA stopped giving aid money to health organizations that offer abortion assistance, under President Trump – this has led to more unsafe abortions, and they account for up to 13 percent of maternal mortality. The US changed its policy in the area in 2021, but it shows how political priorities mean life and death. – There is a need for political focus, says Merete Engell. Massive investments are needed if we are to reach our goal of securing women’s health, she continues. We know what works The good news is that the health problems are not insurmountable. The WHO emphasizes that the world already has the knowledge needed to make great progress. Firstly, abortion can be legalised, which will lead to fewer unsafe abortions – which cost tens of thousands of lives every year. Merete Engell also explains that the biggest causes of death are relatively easy to treat. – The biggest cause of death among women in labor is bleeding after birth, and it can be relatively easily fixed with simple things such as medicine or massage of the uterus outside the abdomen, so the uterus contracts, she says. Merete Engell explains that it requires a lot. Such as education of health personnel, proper connections between health facilities, ambulances, medicine and much more. So it must be prioritized otherwise it won’t happen. – There are so many women who need this.
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The birthing bed is becoming safer worldwide
