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Nearly 300,000 people died during pregnancy or childbirth in 2020. This also includes America, where maternal mortality rate has increased. But India’s MMR is down. Pregnancy means new life for most of us – and a unique experience each time, bringing your baby into this world. But in many cases, pregnancy also means the end of life. In late February 2023, the United Nations released a new report on maternal mortality rates around the world. The report details how every two minutes a woman dies due to complications during childbirth or pregnancy.
“Pregnancy is still a shockingly dangerous experience for millions of people around the world,” said World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus. In the year 2000, the global maternal mortality rate (MMR) was 339. This means that 339 pregnant people of childbearing age died per 100,000 live births. The global MMR in 2020 was 223.
But according to the UN report, most countries around the world have failed to significantly reduce their maternal mortality rate (MMR) in that 20-year period. There was a slight decline between 2000 and 2015, but the global maternal mortality rate has plateaued since 2016, the UN report said. And that’s unacceptable, said Jenny Cresswell, a WHO scientist and co-author of the report.
“The stability is not good at all,” Cresswell told DW. “Sustainable Development Goals [SDG] The goal is to reduce the global maternal mortality ratio to less than 70 maternal deaths per 100,000 live births by 2030. We are currently very far from meeting this goal.”
America: rising maternal mortality rate
In some countries, including developed countries like the US, maternal mortality rates have been increasing over the years. With more than 23, the US has by far the highest MMR of all industrialized countries. The rate increased by approximately 78% between 2000 and 2020. With a low total number, even minor changes result in a high percentage increase in the number. But that doesn’t change the fact that the number of pregnant people dying during pregnancy, childbirth or shortly thereafter has been rising for decades in one of the richest countries in the world.
What is going wrong in America?
It’s not easy to explain why MMR is rising in the US, said Munira Gunja, a senior researcher at the Commonwealth Fund, a foundation that supports independent research on health care issues in the US. Gunja said that many factors can contribute to the condition, including “many underlying health conditions.” [that] “It has been increasing for several years now.”
Then there’s the fact that many Americans don’t have health insurance and can’t afford to visit their doctor. The cost of health services has also increased. And there is a shortage of midwives who can help people during pregnancy. “The rate at which people in America skip [medical] The care is dramatically higher than in other developed countries,” Gunja said. All of this, Gunja said, contributes to “this unacceptable maternal mortality rate.”
But that is not all. MMR in black Americans is about three times higher than in white Americans. This glaring difference is due to “structural racism,” Gunja said. ,[Black Americans] They are at a disadvantage from the beginning: where they live, their level of education, their jobs and salaries. And when they see a doctor, they often encounter outright racism.”
Changes in health care at many levels
Gunja said it would already make a big difference if there were more active midwives in the United States. Midwives can form a close relationship with the pregnant person, caring for them at home and even checking in during the postpartum period – which is when half of all maternal deaths in the US occur. But things may need to change at the clinical and policy levels as well. At the clinical level, health care professionals need to be informed just before, during and after childbirth, said Usha Ranji, associate director of women’s health policy at the Kaiser Family Foundation, a nonprofit organization that focuses on health issues in the US. And the warning signs need to be recognized later. ,
“Some of the factors contributing to maternal death were bleeding during and after delivery as well as sepsis [blood poisoning]Eclampsia and pre-eclampsia [seizures during childbirth],” Ranji said. When these things are not taken care of, they can be fatal.
Ranji said training is improving among doctors and nurses who work in labor and delivery, and “a lot of emphasis is being placed on listening and better communication with patients.” At the policy level, Ranji said it is important for everyone to have health insurance because 10% of women of childbearing age in the US are still uninsured and, as a result, are less likely to seek out and receive the medical care they need. “It’s important to take good care of people before they become pregnant,” Ranji said, “to make sure they are in good health overall.” “But it’s hard to get care when you don’t have health insurance.”
India: On the way to a success story
The UN report said South Asia is one of the few regions in the world where maternal mortality rates are declining. And India has seen the biggest improvement in its MMR. Maternal mortality in India declined by more than 73% between 2000 and 2020. In 2020, India’s MMR stood at 103 nationwide. This is still much higher than the MMR in the US. But while the maternal mortality rate in the US rose at an annual rate of 2.88% from 2000 to 2020, it fell at an annual rate of 6.64% in India during the same period.
Rajib Dasgupta, professor at the Center for Social Medicine and Community Health at Jawaharlal Nehru University in New Delhi, said India has begun to see the benefits of a more liberalized and growing economy over the past two decades. “There has been an overall decline in absolute poverty, sustained growth in key determinants such as women’s education and income, and increased infrastructure,” Dasgupta said.
According to the UN report, all these social factors contribute significantly to improving maternal health and preventing deaths during and after pregnancy. The countries in South Asia that have seen their MMR decline over the past 20 years have “made good progress in economic growth, increased female education and other important areas, all of which play a role,” Cresswell told DW. “She has demonstrated continued political commitment to increasing women’s access to quality maternity services.”
Tackling inequality among Indian states
But experts say India needs more political commitment to spread these reforms across the country. “To reach SDG targets [a maternal mortality rate below 70]Dasgupta said, “More attention should be paid to inequality among Indian states. Many Indian states have achieved the SDG targets. Kerala state has an MMR of 19. It is not the lowest rate in India, but it is a low MMR. ” Compared to the United States.
At the other end of the spectrum is the state of Assam, where the maternal mortality rate is 195, which is 10 times higher than Kerala’s MMR. But things are moving in the right direction in Assam also. Down to Earth, an Indian journal on environment and development policy, reported in late 2022 that Assam’s MMR between 2014 and 2016 was 237. This represents a decline of more than 40 deaths in pregnancy per 100,000 live births.
India is on the right track – it has invested in medical infrastructure and increased the number of medical personnel across the country and now “the time has come to build on this strength,” Dasgupta said.
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