A recent report from WHO, showed that maternal mortality ratios (the number of maternal deaths per 100,000 live births) are declining globally, and in all regions but the decline is far too slow to meet the target of Millennium Development Goal 5, which calls for a 75% reduction from 1990 to 2015. At the global level, maternal mortality has decreased at an average of less than 1% annually between 1990 and 2005 – far below the 5.5% annual decline, necessary to achieve MDG 5. In sub-Saharan Africa, the annual decline has been approximately 0.1%.
Sadly, where you live determines if you live! The adult lifetime risk of maternal death (the probability that a 15-year-old girl will eventually die from a maternal cause) is highest in Africa (1 in 26), followed by Oceania (1 in 62) and Asia (1 in 120), while the developed regions had the smallest lifetime risk (1 in 7,300). Of all 171 countries and territories for which estimates were made, Niger had the highest estimated lifetime risk - 1 in 7, in stark contrast to Ireland, which had the lowest lifetime risk of 1 in 48,000 (WHO, 2008).
Over and above these stark figures, some 10 to 20 million women every year suffer illnesses or disabilities that are directly related to pregnancy and childbirth – women and girls who end up with long-term physical, psychological, social and economic problems. Maternal morbidity is an extremely difficult thing because of differing definitions of what maternal morbidity constitutes; lack of access to healthcare; inadequate diagnosis reporting systems.
Another recent report, this time from a group of British Members of Parliament, gives stunning and graphic examples of the problem (APPGPDRH, 2009). It describes the grim series of complications that result from inadequate care. These include: “Obstetric fistula, perineal damage, prolapsed uterus, stress incontinence, puerperal infection and sepsis, haemorrhage, hypertensive disorders (pre-eclampsia) and fits, anaemia, infertility and ectopic pregnancy, depression and suicide.”
It goes on to say “Maternal morbidity has root causes in gender inequality and violence, poor access to education (especially for girls), early marriage, adolescent pregnancy, poor access to comprehensive quality sexual and reproductive health services and other social and economical determinants. Among the many structural problems in maternal health, the lack of health workers and drugs and supplies, economic inequity, remote populations, the low status of women and a lack of political will or ideologically driven policies are particularly important.”
Concept believes that equitable access to vital maternal health drugs can make a substantial contribution to maternal health and reducing maternal mortality and morbidity. Millions of women either to die or live with significant health problems as a result of complications during pregnancy, child birth and or as a result of unsafe abortion, many of which are avoidable if they had access to inexpensive medicines of assured quality.
Ensuring access to maternal health drugs is scheduled to be a key component of our Business Plan and we are initiating a range of activities in support of this key objective, including the development of products for cervical priming, incomplete abortion and post-partum haemorrhage in collaboration with our partners.
This work includes documenting the quality of misoprostol currently available around the world and reviewing the capability of several existing misoprostol manufacturing facilities and capacities, as well as identifying the need for additional data and studies in support of product introduction.We continue to advocate for broader recognition and use of appropriate maternal health drugs at both the national and international levels, and will work with our partners to provide briefings, materials and advice to a range of organizations, policy-makers and health providers.