Maternal Mortality And Morbidity: Causes, Impacts And Strategies For Reduction

Introduction to Maternal Mortality and Morbidity

Question:

Discuss about the Maternal Mortality and Maternal Morbidity.

Maternal mortality these are death that occur on women during child births. This occurs within 42 days but less than a year after conceiving. Maternal morbidity refers to complications which develop during pregnancy and after child birth. They mainly affect the well being and the health of a woman. Statistics have indicated that 1 out of 6 women dies due the same in the developing world, while as in continents like Europe, 1 out of 5,000 dies due complication related to maternal. In Indonesia, close to eight million women suffer from pregnancy complications which are avoidable while as half a million ends up dying (Ali, Okud & Adam, 2011). It is very disappointing to lose lives while giving birth. However, identification of the main causes of deaths will help put up control standards and come up with proper strategies to deal with the issues. It will help in a reduction of avoidable deaths during child births. Additionally, basic training is important to women infected with incurable diseases to reduce the death rate in women.

According to Ashford (2002), maternal mortality and morbidity rates in Indonesia have the highest figures from the rest of the countries. This was amplified by the non-utilization of the maternal healthcare. This is because they were not able to receive standard World Health Organization antenatal care (ATC) visits. The figure below illustrate on the difference in mortality rates on developing countries compared to the one already developed. The main cause include:

• Hemorrhage- this has greatly contributed to a rise of death accompanied by excessive bleeding. It a major risk factor which is brought about by child birth. However, women bleed heavily leading to approximately 26% of women deaths as researched by World Health Organization. The excessive bleeding becomes uncontrollable especially when discovered too late. The blood is entire drained from the body making the victim so weak thus demise of a life. 
• Infection- they are deaths caused by infection such as HIV, Heart diseases and anemia. Infected diseases such as HIV poses a great risk on the expecting mother. It is however said to claim life especially to those much affected. The same causes deterioration in health where the white blood cells are reduced to a level of not fighting other infections (Filippi et al., 2007). Moreover, in case there is anemia, not enough red blood cells are produced which in return affects the blood circulation in the body. The heart is however affected causing cardiovascular disorders. These will trigger a heart failure leading to death. This contributes to 17% as stated by World Health Organization (WHO) (Chhabra et al., 2008).
• Unsafe abortions- in most cases, women who conceive without their knowledge prefers to have the pregnancy terminated without following the right procedures.  The process is mainly done by unqualified personnel who in return end up causing more damage to the victim. As a result, excessive bleeding and infection are experienced. The womb may be destroyed in the process thus severe implication on health in later days. These being an alternative to eliminating the pregnancy, one is exposed to health risk which may be permanent or even result to the death of the victim.  Women tend to choose this option since in most developing countries, abortion is termed as illegal. They therefore find it necessary to abort without going to the health facilities (Balin, 2005).
• Hypertensive disorders- it is situation associated with an increase in blood pressure. When it shots beyond normal, a great risk is imposed on the mother and the unborn child. In most cases it ends up causing deaths if not handle immediately by the health experts.
• Obstructed labor-even with normal contraction of the uterus during labor, the baby does not get down the cervix. This may result to inadequate supply of oxygen during the child birth process. However, this may result to death of the mother due to a long strain during the process. There is also prolonged labor which results to more straining of the mother thus lacking strength to push the baby. This contributes to less oxygen being inhaled in order to speed up the delivery process. Apparently, the mother becomes unconscious whereby she may end up dead if know proper circulation of oxygenated blood in the body system (Kayem et al., 2011).

The chart below clearly shows on the number of death caused by each the above factors.

Maternal mortality is one of the main medical healthcare challenges across the world most especially to the developing countries, i.e. Indonesia. Currently there is a disappointing increased number of maternal deaths resulting from poor health facilities. Despite the challenge, a number  of countries have made a conspicuously unusual movement, whereby a quarter of the deaths records in maternal mortality takes place Sub Saharan region in Africa since no change has been initiated. There is no direct interference that will consequently help to reduce mortality (Ashford, 2002). 

In a group of ecologist study done by Kayem et al.,(2011), the study compared the diversities between a number of Sub-Saharan in countries using the information data taken between 1996 and 2007. The healthcare system establishes association, economic and education as independent diversities. A relationship between the maternal mortality proportions and some economic, educational and sanitary factors was confirmed or observed in the country. There was an important connection of the maternal mortality ratio with prenatal care coverage, births assisted by qualified and authorized medical practitioner (Amaral et al., 2011).

Statistics of Maternal Mortality and Morbidity in Developing Countries

The financing of medical health individually makes the cost of care an essential factor of demand. In distinction references, the payments can be considerable amount or quantity. For example, the poorest people in Sub-Saharan African countries earn low income making it impossible get good medication. It would be such a shock if such charges did not consider demand; however, the actual proof confirms that they do.  Most of the developing countries find health care to be very costly (Khan et al., 2006).

There is strong derived scheme that the poor are more cautious with their spending than the wealthy ones. An increase of the hospital charges favors the rich over the poor people thus access to crucial services as provided by the law. For example, the abolition of personal fee in   Uganda led to a maximum utilization of the essential services by the poor. If increased charges are combined with quality improvements and the availability of health facilities, there would be a maximum utilization of essential services regardless of the status. Informal payments are the inconsiderable amount in many public health care systems (Haddad et al., 2011).Additionary,other hindrances in the maternal morbidity in Indonesia include inadequate quality care received during the antenatal care visits, wealth disparities in the country in that there are greater  disparities in urban compared to rural areas because antenatal care services are high unlike in rural areas where they are of low quality due to lack of proper infrastructure to develop them, among others.

Different strategies can be adopted in Indonesia to help address the high cases and rates of maternal mortality and morbidity rate in the country. Some of the key strategies involves investing in qualified medical person to take care of the patient during and after the patient has given birth. Trained personnel provides the basis for assisting mothers and effectively preventing maternal mortality which is influenced by the quality of care provided in healthcare settings (Haddad et al., 2011). Additionally, the knowledge and skills gained by the healthcare providers empowers them to effectively help the patients as well as educate them on maternal mortality and the associated risk factors. Educating the people to change and making an improvement in childbirth delivery in hospitals and clinics, and this is achieved by focusing on quality maternal and child health services by delivering facilities that are equipped with emergency and obstetric and neonatal care services. The strategy is required since some of the healthcare providers lack enough knowledge and skills to identify the patients at risk (Furuta, Sandall & Bick, 2012).

Causes of Maternal Mortality and Morbidity

The second key strategy that can be adopted involves improving the resource need of the hospital and clinics, which are used in the surgical emergency. In most cases pregnant women require emergency services or care in order to prevent the cases of maternal mortality which is prevalent in the Indonesia. However, the lack of resources and service facilities in healthcare settings is a key contributor to the high death rate, which creates the need to ensure the healthcare organizations have the necessary resources (Ellison, De Wet, Matshidze & Cooper, 2000).

The third key strategy that can be adopted to address the high cases of maternal mortality and morbidity in Indonesia, involves focusing on the healthcare providers through concession or increase payment to the doctors and nurse can motivate and give a better service. Motivation of the healthcare providers provides the basis for empowering them to deliver high quality care as well as enhance their commitment to address the patient’s problems in order to address the maternal mortality rate (Filippi et al, 2000). The strategy is effective since it enhances the ability of the healthcare providers to deliver quality patient-centered care as well as continually engage the patients in order to promote positive outcomes (Khan et al., 2006).

Another key strategy which is critical in the developing countries involves establishing training and education programs for young girls and women on maternal mortality and the risk factors. Such programs are critical since a majority of the pregnant women in Indonesia lack the knowledge on the risk factors that influence maternal mortality. This is achieved by promoting the preventive health programs which will requires promoting a continuum of care right from adolescent and pre-pregnancy period through pregnancy, delivering up to childhood. The interventions involved should be proved, cost effective and should have a positive impact to the community and the public in general. Community should be able to manage common  cases like childhood illnesses,brestfeeding,promotion and counselling, by providing supplements like the folic acid, in the preconceiving stage, maternal use of insecticide-treated bed nets; and having proper ways of limiting mother to child transmission of HIV/AIDS by providing community testing and counseling for pregnant women and the public at arge.According to Hardee, Gay & Blanc (2012), there comprise of more than a half of the world population who are not educated or illiterate and more than two thirds of the world‘s poorest human beings. Women being educate can lead them to have good health and can uplift the community from diseases which is a huge problem.

Strategies for Reducing Maternal Mortality and Morbidity

Another key strategy involves encouraging women and young girls to formulate or join existing groups so as to have a voice to speak against neglecting and so that they can have success in policy development that promotes the chances of understanding their risk factors. Establishing laws or policies on maternal morbidity and mortality can help in reducing the risk factors such as early abortion which is a key contributor. This can be achieved by creating awareness among the young people or youth to avoid misbehaviors like unprotected intercourse, drug abuse among others. Establishing laws and effectively ensuring compliance promotes the chances of addressing the risk factors, come up with the effective measures to curb them as well as promoting the healthcare providers commitment to the health issue will help in raising up a healthy community (Calvert et al., 2012).

According to Dolea & Stein (2003), expanding maternal health services to different areas can also significantly help in reducing the mortality rate since a majority of the cases are influenced by poor access to the healthcare services primarily in rural settings. Based on the idea that the country is developing, the healthcare system is not well established which contributes to the high rate of death (Filippi et al., 2007). However, government support in the expansion of maternal health services can play a significant role in reducing the mortality rate as well as educating the population on the risk factors and how to avoid them. The government should work towards supporting the communities, districts and cities that have insufficient infrastructures to achieve the minimum service standards by setting standards that that will ensure regional or geographic balance through equal wealth distribution and delivery of service without favoring either side. Besides, the government can also support that objective by reducing the overall cost of care which also limits effective access to healthcare. A reduction of the patient fees for health care and other services such as emergency transport and mobile healthcare support can reduce maternal mortality (Kaye, Kakaire & Osinde, 2011).

On the other hand, empowering women to leadership and constant engagement with the community members can help spread knowledge and ideas on the risk factors as well as support policies that help reduce the mortality rate. The mothers or women and the health workers should be trained on how to prevent and treat common childhood diseases in order to curb the high level of deaths that results from common infections like diarrhea ,acute respiratory and malaria, which can be prevented.However,they require timely recognition,knowledge,treatment and by implementing standard by the public and private healthcare providers. The aspect further promotes access to quality and reliable healthcare services thus reducing the overall maternal mortality and morbidity rate. The strategy is deemed effective since it increases knowledge and understanding on the risk factors while supporting the care provided by effective policies. Additionally, a collaborative approach to healthcare provision can play a significant role in addressing the maternal mortality and morbidity rate by ensuring all the key stakeholders play a key part in improving the care provision and education to the pregnant women (Dolea & Abouzahr, 2003). A collaborative approach ensures widespread commitment to reducing the high cases of mortality as well as supporting positive outcomes. Mothers should be taught on the importance of breastfeeding because from the 2007 IDHS reports indicates that infants under the age of six months were breastfed exclusively (Ministry of Health, 2008). This showed that majority of infants in Indonesia did not receive the benefits of breastmilk. Therefore, constant training and creating awareness will help in educating the mothers the importance of breastfeeding their children, among them being nutritional benefits and protection against diseases. It also helps address key issues such as resource need and educational needs. (Hardee, Gay & Blanc, 2012).

Investing in Qualified Healthcare Providers

Conclusion

Women in the developing countries tend to acquire poor treatment or none at all. However, analytical approach of the current problems will help reduce mortality rate in the rural or semi-urban areas. It is therefore important to adopt the SMI (Safe Motherhood Initiative) in the Sub-Saharan Africa since the same was implement two decade ago in the developed countries. Such initiatives have a significant role in empowering women with necessary knowledge and skills to effectively address the maternal mortality risk factors. Additionally, it plays a significant role in enhancing the government’s commitment to the overall improvement of the maternal mortality as well as enhancing the quality of care. This will help prevent the invisible death during child birth. It is necessary to invest in good clinic and hospital to avoid more death from happening. A collaborative approach can also help in addressing the maternal mortality rate by ensuring all the key stakeholders are involved in supporting pregnant women in reducing the risk factors.

At national level, the private health providers should collaborate with government and be part of making the health policies and frameworks so that the combined efforts will ensure that the services provided are of high standards .Private healthcare providers and the training facilities plays a major role in Indonesian health system and joining hands with the government health policies, information delivery systems and standards will ensure a healthy population is grown and taken care of. Regulation, inspection and the certification of private healthcare providers should comply with the government standards and information systems so that they can deliver their services and be reliable to the public at large. Heath information systems in Indonesia need to be harmonized and re-centralized in certain ways relating to the health information systems, especially those regarding processes, reports and standards so that the public can get the health information at the right time, form and acted upon.

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Improving Resource Allocation in Healthcare Settings

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