Reducing Maternal Mortality: Can we derive policy guidance from developing country experiences?

Abstract

Developing countries are floundering in their efforts to meet the Millennium Development Goal of reducing maternal mortality by 75% by 2015. Two issues are being debated. Is it doable within this time frame? And is it affordable? Malaysia and Sri Lanka have in the past 50 years repeatedly halved their maternal mortality ratio (MMR) every 7-10 years to reduce MMR from over 500 to below 50. Experience from four other developing countries--Bolivia, Yunan in China, Egypt, and Jamaica-confirms that each was able to halve MMR in less than 10 years beginning from levels of 200-300. Malaysia and Sri Lanka, invested modestly (but wisely)--less than 0.4% of GDP--on maternal health throughout the period of decline, although the large majority of women depended on publicly funded maternal health care. Analysis of their experience suggests that provision of access to and removal of barriers for the use of skilled birth attendance has been the key. This included professionalization of midwifery and phasing out of traditional birth attendants; monitoring births and maternal deaths and use of such information for high profile advocacy on the importance of reducing maternal death; and addressing critical gaps in the health system; and reducing disparities between different groups through special attention to the poor and disadvantaged populations.

A community-based participatory research approach to explore community perceptions of the quality of maternal–newborn health services in the Dominican Republic

“…Providers have demonstrated disrespectful attitudes towards patients as well as compassion fatigue (Harvey, et al 2007; Barber, 2006; Barros, et al, 2003; Boller, et al, 2003; Miller, et al, 2003). It is worth noting, however, that there are also reports of achievements in quality of care focused on reduction of disparities and structural efforts to increase skilled birth attendance (Clapham, et al, 2004; Liljestrand & Pathmanathan, 2004). …”

Postoperative outcome of caesarean sections and other major emergency obstetric surgery by clinical officers and medical officers in Malawi

“…to reduce maternal mortality by 75% – based on the level in 1990 – within the next eight years. Success stories from Sri Lanka [7] and Malaysia [8] point to human resources as a crucial factor in reducing maternal mortality. In order to cope with the ever-increasing demand for health care, Malawi introduced a cadre of mid-level health care providers called clinical officers (COs) as early as 1976.…”

Reconstruction of health service systems in the post-conflict Northern Province in Sri Lanka

“…Although both sides have kept the cease-fire for more than 3 years, the peace negotiation has been disrupted since April 2003, thus a long-term prospect for peace is uncertain at present. Sri Lanka is famous for its relatively sufficient basic health and educational indicators in comparison with other similar economical-level countries [6]. Even during the prolonged conflict, Sri Lankan people enjoyed the benefits of social services such as health and education.…”