Developing World: Maternal and Neonatal Mortality

Baroness Hodgson of Abinger Excerpts

Thursday 15th January 2015 Lords Chamber

[Baroness Hodgson of Abinger (Con)]

My Lords, nearly every minute of every day a woman dies from complications in pregnancy and childbirth. Yesterday 800 women across the world died; 800 will die today and every day until the end of the year and into next. On average, 9,000 babies will die at birth or in the first week of life each day of this year too. In this day and age these are truly shocking figures.

I congratulate the noble Baroness, Lady Hayman, on having secured this debate which encompasses two of the most important millennium development goals—to reduce child mortality and to improve maternal health. Of course, these two goals go hand in hand and I am heartened that the title of this debate recognises it.

There has been improvement. Since 1990, maternal mortality has declined by nearly half. Although progress has been made in all developing regions, as we have already heard, there are vast geographical disparities and it is now estimated that 99% of maternal deaths occur in developing countries. In 2013, the maternal mortality ratio in developing countries was 230 per 100,000 live births, compared to 16 per 100,000 in the developed world. For example, one woman in 30,000 dies as a result of pregnancy and childbirth in Sweden, whereas in Afghanistan it is about one in six. So many of these deaths are preventable. These women will not have had the pain relief and epidurals that we have come to expect here. Many will have had to endure many hours of excruciating and unbearable pain before they die.

Neonatal mortality rates have also declined significantly over the past 20 years, but to have between 3 million and 4 million babies a year currently dying is truly appalling. Cocooned in the Palace of Westminster, we might find these overwhelming impersonal statistics numbing, but we should remember that each and every one of these deaths is a devastating tragedy for those involved. It is a tragedy for the children who lose a mother—and children who have lost their mothers are 10 times more likely to die prematurely—and a tragedy for the mother who loses a baby. In the West these losses are mercifully rare but, having lost a baby at birth myself, I know personally that it is a very hard thing ever to come to terms with.

For every woman who dies, at least 20 more suffer complications which may leave them with lifelong crippling disability and pain. Lack of obstetric care may result in fistula, resulting in them being shunned by their families and the community. Traumatic births can cause postnatal depression—something rarely mentioned in the context of developing countries. Today in the UK, 10% to 20% of women develop a mental illness during pregnancy or within the first year after having a baby. With the right help, women can recover but, without that help, they may never be able to function properly again. For a baby, even slight oxygen deprivation at birth may cause life-changing damage—either physical or mental.

Many of these deaths are avoidable but, to ensure the fundamental well-being and survival of both mothers and babies, every woman needs access to a trained doctor or midwife. In countries such as Afghanistan, only 14% of births are attended by a health worker. Every year, across the world, 46 million babies are delivered without any skilled assistance.

I have seen the challenges from my visits to various countries. For example, I remember visiting the district hospital in Koinadugu in Northern Province, Sierra Leone a few years ago. There was only one doctor in the hospital, who was also the district health administrator. He explained that some of the villages in the district were 100 miles away from the hospital and there were no roads. Although there was a system of outlying clinics, none had doctors and most had no trained nurses either. The radio system to them from the hospital was broken. There are similar tales in many other developing countries. So it is not just about ensuring that there are enough doctors and midwives in these countries; it is also about ensuring that the medical care that is so vitally needed can be reached.

Harmful traditional practices such as FGM and early marriage, all too prevalent in some developing countries, also contribute to maternal and child mortality. Lack of adequate nutrition can also be a cause. Lack of gender equality impacts, too. For example, there are clear connections between women’s lack of access to education and reproductive rights and health. In some countries, girls commonly have to leave school due to pregnancy or for early marriage—that is, if they have attended school at all. I recently visited Mali, which has one of the highest child marriage rates in the world. Half of the girls there will be married before they are 18. In addition to greater vulnerability to domestic violence and the contracting of diseases, these child brides are more likely to bear children before they are physically ready, thus exposing them to extreme risk. Newborn baby deaths are also 50% higher when born to those under 20.

Women need to be empowered in a wider cultural sense by having control over their sexual and reproductive activity. It is estimated that 215 million women in the developing world want to delay or avoid pregnancy, with as many as 50% of pregnancies being unplanned and 25% unwanted. Having to have baby after baby wears a woman out, with each pregnancy multiplying her chance of dying from complications. It is estimated that a third of these deaths could be avoided if women had access to contraception services, which would help avert unintended and closely spaced pregnancies and reduce instances of unsafe abortions. This is because one-quarter of all pregnancies end in abortion and 19 million of those abortions are unsafe, resulting in 68,000 deaths per year and many women suffering complications and infections. So the provision of proper contraception is crucial in improving reproductive health and tackling maternal mortality.

I particularly welcome the debate today, as in spite of the improvement of the last 20 years the situation is still unacceptable. We need to be resolute in tackling the causes in developing countries because we still have a long way to go until every woman and child across the world receives the care that we, in the western world, take for granted.