There’s an African proverb that says, “The sun should not set twice on a laboring woman.” In other words, if labor goes on for longer than a day, then something is critically wrong. That was the case for Mercy, a 27-year-old would-be mother in Kenya. She’d been in labor at home for hours before finally heading to a hospital in Mumias, where she delivered her baby. Then, she hemorrhaged and died due to massive blood loss.
Mercy’s name has been changed for privacy and out of respect to her and the family she leaves behind, but there are a million permutations of this heartbreaking story. In fact, a scene like this – in which a mother like Mercy dies from childbirth complications – plays out once every two minutes. Postpartum hemorrhage is the leading cause of maternal mortality, resulting in 70,000 preventable deaths each year globally. In early October, in a move that sends a strong signal about global health priorities, the World Health Organization issued its first “roadmap” for tackling this scourge.
It is a tragedy that women are still dying while trying to bring children into the world. This should not be happening. Ever. And for every woman who dies, an estimated 30 suffer severe and ongoing complications such as infections, kidney disease, genital ulceration and sores and obstetric fistula.
Fortunately, more eyes are on maternal mortality. A new report from the Bill and Melinda Gates Foundation sounds the alarm about the woefully inadequate level of support that exists for improving maternal health outcomes globally despite low-cost, accessible ways to help.
In a special essay for the report, foundation co-chair Melinda French Gates writes, “For nearly all of human history, we simply didn’t know enough about preventing or treating the common childbirth complications that lead to death, such as postpartum hemorrhage or infection. Today, we know a great deal. Yet, as is so often the case in global health, innovations aren’t making their way to the people who need them most.”
The maddening thing is that there are cost-effective interventions that have the potential to save thousands of mothers like Mercy. For example, PPH is better identified by using a low-cost obstetric drape that allows doctors to quickly gauge how much blood a woman is losing during delivery, preventing deadly or debilitating blood loss. Similarly, a common cause of PPH, anemia, can be managed by providing a one-time, 15-minute intravenous infusion of iron to women during a prenatal visit.
Lifesaving solutions exist today, and the ones that the Gates Foundation highlights – such as ultrasounds and early screening – are proven and cost-effective. So, the problem with maternal mortality isn’t that women are dying, and we don’t know what to do about it. Rather, it’s that the global community, including governments and philanthropists, haven’t stepped up to invest in these proven interventions to save the lives of moms.
Moreover, in low-income countries, the crisis in maternal health extends far beyond the risk of mortality. When it’s not deadly, PPH can be debilitating, causing long-term complications like heart or kidney failure. Similarly, obstetric fistula – a childbirth injury that leaves a hole between the vagina and the bladder or rectum – is a condition that can have devastating, long-term consequences for the more than 1 million women who suffer from it worldwide, according to WHO data.
While a fistula is not a death sentence, it can feel like a life sentence. Typically, a woman with one loses her child amid traumatic and prolonged labor. Then, she begins to leak urine or feces (or both) uncontrollably from her vagina. More often than not, her husband abandons her.
A fistula, in short, marks the end of her life as she knows it. The women we help often tell us that it’s a fate worse than death. However, a relatively low-cost surgery can cure them for life.
A critical shift is happening in the global health discourse when it comes to maternal mortality. Gone are the days when we end our work at “saving lives.” The women who survive childbirth complications deserve not just a life, but a full life that they can enjoy with their family and community. If a known and affordable intervention exists for maternal morbidities like PPH or fistula, why aren’t we investing in it as earnestly as interventions for maternal mortality?
Organizations and advocates are challenging governments and philanthropists to deliver solutions to help ensure women like Mercy don’t die preventable deaths. Now, let’s use the same data-driven framework to champion interventions for the other half of the coin – the women who survive a traumatic birth but need a little help to lead full, healthy and productive lives.