A pregnant mother or newborn dies every seven seconds, according to new data from the World Health Organization. Tragically, these numbers have not improved over the last eight years.
Internationally, we are seeing 1.9 million stillbirths, 2.3 million newborns die under the age of one month, and around 300,000 maternal deaths occurring annually. With roughly 134 million babies born worldwide, we are still seeing a shockingly high stillborn and infant mortality rate of over 3%.
While these are heart-wrenching numbers, it is most distressing that the vast majority of deaths are preventable. The most common causes of neonatal mortality are pre-term birth, complications during the delivery, infection and birth defects.
Most children who die within the first 28 days of life were affected by one or more of the above or did not receive quality care within the first few moments of life. Because many developing countries are “maternity care deserts” where mothers cannot secure reliable prenatal care, we are witnessing an epidemic of premature births.
Today, prematurity is the leading cause of death for children under five-years-old, surpassing pneumonia, diarrhea, birth defects and malaria. In 2020, 47% of under-five deaths were within the first 28 days of life which is up 17.5% from 1990. These children were born without even a fighting chance.
In developed countries, preterm infants are sent to Neonatal Intensive Care Units until they can survive on their own, but less than a third of reporting countries claimed to have sufficient resources to meet demand.
In order to combat the growing rate of prematurity, the WHO doubled its recommended number of antenatal care visits from four to eight in 2016. The new guidelines recommended that a patients have their first visit within the first 12-weeks of gestation and then at 20, 26, 30, 34, 36, 38 and 40 weeks.
In addition, the guidelines focus upon testing, vaccination, the use of ultrasound and education about nutrition, tobacco and substance use while providing malaria and HIV prevention.
These recommendations were expected to potentially reduce perinatal mortality by eight deaths per 1,000 births. In 2015, only 64% of expecting mothers received at least four prenatal care visits. Now, unfortunately, that number has fallen to less than 60%.
We are not improving. We are seeing more and more at-risk mothers and children. So, it is time to rethink our approach.
The burden is most evident in Sub-Saharan Africa, which sees 27 deaths per 1,000 live births. This is followed by southern Asia at 23 deaths per 1,000 live births. These two regions account for almost 80% of the world’s neonatal deaths.
In comparison, the average affluent country has a mortality rate of 3.8 deaths per 1,000 live births. A newborn is seven times more likely to die in Sub-Saharan Africa than in advanced economies. The leading problem is lack of resources in these areas.
In affluent countries, 99% of births are attended by a medical professional (physician, nurse, midwife, etc.) and 98% of women receive some degree of prenatal care.
In contrast, developing countries only saw 55% of births attended by a professional, while 59% of mothers received some level of prenatal care. Only a fraction come close to receiving the recommended eight prenatal visits.
A survey of Sub-Saharan African women revealed that 61.5% were unsatisfied with prenatal services because they were inefficient and the patients were treated poorly.
In addition, less than 64% of the population even has a chance to have access to trained birthing professionals. This translates to around 37.5% of mothers who had at least four prenatal care visits and 28% who had a professional at their delivery.
The region has 170 million people who live more than two hours from a hospital and not all these facilities offer the full range of obstetric care. That is way too far to travel for a patient who has gone into labor or who has a baby in distress. Therefore, access to prenatal care and birthing centers is a leading problem.
The issue extends beyond Africa and southern Asia, as 60 countries worldwide are not on target to meet the 2030 Sustainable Development Goals for maternal, newborn and stillborn mortality reduction targets.
It is important to note that mortality rates are linked to more than just access alone. Cultural and religious beliefs, political instability and government corruption all contribute to the inability to improve these rates.
However, the disparity of access described above illustrates the growing chasm between affluent countries and those that are struggling to provide basic services.
Ironically, while the U.S. is focused on debates about abortion, one would hope that maternal and infant mortality rates could be something everyone could agree upon and work to address.
While the mortality rate will never be zero, no woman should have to worry if she or her baby will be just another statistic that the rest of the world didn’t care about.
Senior Staff Chaplain and Clinical Ethicist at the Baptist Health Medical Center in Little Rock, Arkansas.