Low-cost health measures could drive big fall in maternal mortality, says report

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A series of low-cost measures to make childbirth safer could save the lives of 2mn more mothers and babies around the world by 2030, said a leading philanthropic organisation.

The Bill & Melinda Gates Foundation on Tuesday said since 2016 progress in reducing global maternal mortality had stalled, partly because of disruption caused by the coronavirus pandemic. In some countries, including the US and Venezuela, maternal death rates had risen in recent years.

With nearly 800 women dying in childbirth every day, the foundation called for “immediate action” to meet the UN’s sustainable development goal of cutting the maternal mortality rate to less than 70 out of 100,000 births, and newborn mortality to at least as low as 12 deaths per 1,000 births, by 2030. The current projection is for 138 maternal deaths per 100,000 births by that date, or almost double the target, it said.

Foundation co-chairs Melinda French Gates and Bill Gates outlined seven “innovations” and practices — many low-cost and deliverable by midwives and birth attendants — that could prevent deaths from childbirth complications such as post-partum haemorrhages, sepsis and other infections. Measures such as increased use of antibiotics and anaemia treatments including micronutrient supplements could save 2mn additional lives by 2030, and 6.4mn lives by 2040, they added.

The report said “policy changes . . . and more investment in women’s health and healthcare workers, including midwives” would be needed to reduce maternal mortality.

Launching the report, Mark Suzman, the foundation’s chief executive, said “huge progress” had been made in reducing deaths during childbirth in low- and middle-income countries in sub-Saharan Africa, South Asia and other regions. Between 2000 and 2015, preventable child mortality had more than halved to fewer than 5mn deaths a year, he said.

Progress had first slowed then stalled “largely [as] a result of the Covid-19 crisis” that had “disrupted health systems and restricted funding”, he said.

The report noted 18 key indicators in the UN’s SDGs — from poverty to gender equality, education to food security, health to climate — may not be achieved by the 2030 target.

But if health authorities implemented the recommended innovations and increased use of vaccines or malaria bed nets, “then it’s absolutely possible to reverse the setbacks and to reach the SDGs”, Suzman added.

Professor Bosede Afolabi, head of obstetrics and gynaecology at Nigeria’s Lagos university, told the news conference that giving micronutrient supplements to anaemic women during pregnancy reduced the numbers of stillborn children by about 21 per cent and low birth weights by 19 per cent while also reducing “six-month infant mortality to a large extent”.

Anaemia affects as many as 37 per cent of pregnant women globally. In some places in South Asia, that rate jumped as high as 80 per cent, the report noted.

In a trial across sub-Saharan Africa, use of the antibiotic azithromycin reduced sepsis cases by a third. French Gates added it could also be a game-changer in the US, where sepsis causes 23 per cent of maternal deaths and which had some of the most “inequitable maternal mortality rates among high-income countries”.

Robert Yates, director of the global health programme at London-based think-tank Chatham House, said Covid-19 had exposed global under-investment in health. While he welcomed investment in the interventions recommended by the Gates Foundation, increased funding in infrastructure, workers, ambulances and commodities was also required.

“If we’re going to see improvements in maternal mortality, there’s a role for the international community to help,” he said, but added it would be “big increases in domestic public financing [that will] make the difference”.