Education key to maternal and newborn health [Archives:2009/1228/Front Page]

January 26 2009
Eight Yemeni women die a day due to pregnancy or childbearing complications. (YT photo by Amira Al-Sharif)
Eight Yemeni women die a day due to pregnancy or childbearing complications. (YT photo by Amira Al-Sharif)
Salma Ismail
SANA'A Jan. 25 ) Childbirth and pregnancy are generally considered times of great joy, but, for women in developing countries, these are times of deadly risk.

According to 'The State of the World's Children 2009' report, launched by the United Nations Children's Fund (UNICEF) on January 15 in South Africa, women in the world's least developed countries are 300 times more likely to die in childbirth or from pregnancy-related complications than women in developed countries.

In Yemen, eight women die each day due to pregnancy or childbearing complications with only 24 percent of births taking place at hospitals or with skilled birth attendants.

The halfway point for meeting the UN's fourth and fifth Millennium Development Goals (MDGs) -to globally reduce under-five child mortality by two thirds and reduce maternal mortality by three quarters between 1990 and 2015- has come and gone, and the two goals are still far from having been met.

Although Yemen is not among the top ten countries with the highest lifetime risk of maternal death, the lifetime risk of maternal death in Yemen is 1:39, making it the highest in the Middle East.

The report states that the ten countries with the highest lifetime risk of maternal death are Niger, with a maternal mortality ratio of 1:7, Afghanistan, 1:8, Sierra Leone, 1:8, Chad, 1:11 Angola, 1:12, Liberia, 1:12, Somalia, 1:12, the Democratic Republic of Congo, 1:22, Guinea-Bissau, 1:13, and Mali, 1:15.

“Two thirds of all maternal deaths occur in just 10 countries: India and Nigeria together account for one third of maternal deaths worldwide,” said UNICEF Executive Director Ann M. Veneman.

In the developing world, a woman has a 1 in 76 lifetime risk of maternal death, compared with a probability of just 1 in 8000 for women in industrialized countries. The need for comprehensive action is paramount.

“Every year, more than half a million women die as a result of pregnancy or childbirth complications, including about 70,000 girls and young women aged 15 to 19,” said Veneman.

The report also ranks Yemen number 48 in terms of its estimated under-five mortality for 2007. That's better off than countries like Sierra Leone, which ranks first, Afghanistan, second, Mali, sixth, Somalia, 19th, Ethiopia, 27th, and Pakistan, 43rd. The rate of survival for children less than five years of age is improving globally but the risks faced by infants in their first 28 days remain at unacceptably high levels in many countries.

The life expectancy in Yemen for 2007 is 62 years; in 1990 it was 54 years.

Developing health systems

The health and survival of mothers and their newborns are linked, and many of the interventions that save new mothers' lives also benefit their infants. The report highlights the link between maternal and neonatal survival, and the vulnerability of both mothers and infants in the days and weeks after birth, a critical time for life-saving interventions, such as post-natal visits, proper hygiene, and counseling about the danger signs of maternal and newborn health.

The report reiterates a widely-known truth, that there is nothing mystical about maternal and neo-natal mortality. The reasons why women and babies die from causes related to pregnancy and childbirth are well understood. Addressing them requires good data and analysis, sound strategies, adequate resources, political commitment and collaborative partnerships. The weakness of health systems requires country-specific actions.

The opportunity to save the lives of thousands of women and children lies within reach. Research has shown that approximately 80 percent of maternal deaths could be averted if women had access to essential maternity and basic health-care services.

In Yemen, doctors and health centers are not equally distributed. There is only one doctor per 10,000 people as doctors tend to be concentrated only in main cities, namely Sana'a, Aden and Taiz. Health services reach only 60 percent of the country's 22 million people.

UNICEF coordinates with the Yemeni Social Affairs Ministry to carry out house care for the mother and the child. It has set out a project for providing clean health services in five governorates of Taiz, Lahj, Ibb, Hodeidah and Dhale' and will last till 2011.

The report also affirms that health services are most effective in an environment that is supportive of women's empowerment, protection and education.

Education is key

Women's empowerment begins with education. Research repeatedly proves that educated women are more likely to delay marriage and hence less likely to get pregnant while they are still children themselves.

Educated women are better equipped to earn income to support their families, more likely to invest in their children's nutrition and healthcare and more inclined to participate in civic life and to advocate for community development.

Educated women are more likely to seek proper health care for themselves, according to the 2007 Millennium Development Goals Report: “Eighty-four percent of women who have completed secondary or higher education are attended by skilled personnel during childbirth, more than twice the rate of mothers with no formal education.”

“Saving the lives of mothers and their newborns requires more than just medical intervention,” Veneman says. Stressing the importance of education she adds, “Educating girls is pivotal to improving maternal and neonatal health and also benefits families and societies.”

Almost 53 percent of Yemen's children suffer from malnutrition and stunted growth. This affects children physically, but it also robs them of mental capacity, handicapping their future and the nation's potential. Children who are malnourished can be brought back to health, but a mind that is unfed can starve for a lifetime.

Two thirds of women in Yemen are illiterate and UNICEF is working with the government to enroll girls into school to receive a full education. The report says that literacy rate for women aged 15-24 is at 67 percent.

Although much remains to be done, the training and recruitment of female teachers is bringing swift progression in some parts of Yemen.

Meeting Goals

The implementation of UNICEF's goals would undoubtedly reduce the death and suffering of mothers and children around the world. However, under conditions of growing global social inequality, the threat of worldwide recession, economic turmoil and an increased turn to militarism, whatever minimal pledges may have been made by the world's leading powers in the past to address the plight of those at the bottom of the development indices, they are likely to fall off the agenda in the coming period.

Millennium Develop Goal 4 calls for a two-third reduction of the maternal mortality rate by 2015. In order to meet this target, the world will have to achieve a 70 percent reduction in maternal deaths between 2005 and 2015.

Following the global financial crisis, governments, NGOs and charitable organizations can be expected to cut expenses on social programs -not expand them- this year.

The failure to keep up the pace to meet the UN Millennium Development Goals on a host of social issues indicate that conditions for vast numbers of the world's women, children and men could decline in the coming years.

“As the 2015 deadline for Millennium Development Goals draws closer, the challenge for improving maternal and newborn health goes beyond meeting the goals; it lies in preventing needless tragedy,” said Veneman.