The field of maternal and child health has largely been focused on child health and how maternal health influences child health. It is a huge mistake for international agencies to view maternal health merely as a vehicle to ensure a child’s health rather than seeing maternal health as innately beneficial. Women in developing countries are responsible for producing 3/4ths of the food and are often the key indicators for family health for generations. Women are vital to a society’s functioning and prosperity, yet maternal health is often tossed aside as an additional benefit to reducing infant mortality. Not only is maternal health not given enough attention, but when it does receive attention the focus is often on improving facility access. However, ensuring maternal health is not about simply reducing maternal mortality by providing to an adequate facility and deliver in the presence of a trained attendant.
Maternal health is about all the factors that go into a mother’s pregnancy, the habits and environment surrounding her pregnancy, and the overall health of the mother after delivery. To deal with maternal health both social and environmental factors have to be analyzed. Social factors influencing maternal health include as discrimination, social status, poverty, and education and environmental factors. Environmental factors include quality of water, quality of diet and access to proper nutrients, air pollution, and basic exposure to the elements. These environmental factors are often reflective of a mother’s status especially poverty. A woman in poverty is much more likely to be negatively exposed to such environmental factors than a rich woman who has better access to quality food and water and improved sanitation.
The biggest contributor to maternal health is hemorrhaging, which contributes to 38% of all maternal deaths in India. Hemorrhage occurrences can be reduced with increased access to facilities but mothers still need to have the funds to pay for such access and many mothers cannot afford to go to hospitals, thus poverty plays a huge factor in access to health care. While hemorrhage is the biggest contributor to maternal death, conditions like sepsis, hypertensive disorder and other conditions like anemia make up over 50% of all deaths (Vora et. al., 2009). Sepsis and various other conditions are largely due to environmental factors that are also caused by social issues like poverty and social status. Sepsis is a bacterial infection that can occur from open wounds; people with low immune systems are the most highly at risk (Sepsis, 2010). Impoverished women are constantly in contact with poor sanitary conditions that are breeding grounds for bacteria and often times when a women gets a cut she is not going to seek care. Sepsis can be a life threatening disease that could be prevent by simply providing women with access to improved sanitary conditions.
Maternal health could be increased by focusing on three specific factors: literacy rates, fertility rates, and age of marriage. All three of these factors indicate a gain in education which translates into a gain in health because women learn why and how to eat nutritious foods, why sanitation is important, and are becoming empowered so that they can seek a paying job. Allowing women to hold a paying job is significantly important for a family because a woman is much more likely to spend her money on her family’s overall health and well being. If a woman is able to feed her and the family the proper nutrients needs, there is less of a chance that the mother will die in labor due to maternal depletion syndrome. Education will also allow a woman to understand the consequences of not going to an institution to give birth. A study showed that in India only 18% of illiterate mothers had institutional deliveries compared to 86% of mothers with 12 or more years of education (Vora et. at., 2009). Many women in India are not fond of government sponsored facilities so if they cannot afford a private facility they will opt for a home delivery which is much more dangerous. Perhaps with an education women will be more likely to accept care at a government facility because they will understand the implications of not seeking care.
India is accounted for at least 1/4ths of all maternal deaths with 301 deaths per 100,000 live births (Vora et. al., 2009). While maternal deaths are high for India as a whole, there is regional variation that reflects on how various factors influence maternal mortality. Southern India has a much lower maternal mortality rate than the north which may be attributed to higher female literacy rates, lower fertility rates, and a higher average age of marriage. Tamil Nadu is located in the southern region and has a fertility rate of 1.7, a mean age of marriage at 22 and a female literacy rate of 64.4%. All o f these factors contribute to its maternal mortality rate of 134 deaths per 100,000 live births (Vora et. al., 2009). In contrast, Rajasthan is in the northern region of India and has a fertility rate of 3.7, a mean age of marriage at 20 and a female literacy rate of 43.8%. The maternal mortality rate for the state is much higher than the average for India at 445 maternal deaths per 100,000 live births (Vora et. al., 2009). In achieving maternal health it is possible that fertility rates will go down as well, placing much less of a burden on society and families in developing countries.
Changing fertility rates can also reduce maternal deaths by reducing the proportion of high risk deliveries (Koblinsky et. al., 2008). For example, in Bangladesh the total fertility fell by 3.6 children from 1970 to 2004, which corresponded to the reduction in the number of pregnancies which placed women at the risk of maternal death. Research also showed that risk of maternal mortality reduced for births 1-3 from 1976-2005 when various program were introduced to reduce maternal mortality but after the 3rd birth the risk of death did not decrease with any of the factors. This shows that reducing fertility is essential in reducing maternal mortality.
Maternal health is a very complex issue that involves various social and environmental factors. Maternal health and maternal mortality cannot be cured by focusing on one aspect; the issue of maternal health needs to be viewed in a comprehensive manner. Political parties, international organizations, communities, and governments do not give maternal health the proper attention that it deserves considering all the effects that it has on not only infant mortality but overall family and societal health. Communication has to be increased throughout these groups to increase understanding about both the complexities and the importance of dealing with maternal health.
References
Koblinsky, M., et al. (2008). Reducing maternal mortality and improving maternal health: Bangladesh and mdg 5. Journal of Health, Population, and Nutrition, 26(3): 280-294. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2740701/
Sepsis. (2010). A.d.a.m. medical encyclopedia. Retrieved September 1, 2011, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001687/
Vora, K., et al. (2009). Maternal health situation in india: a case study. Journal of Health, Population, and Nutrition, 27(2): 184-201. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19489415
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