B!RTH Blog: Dr Charles Ameh, Centre for Maternal and Newborn Health, LSTM

What are the main birth inequalities that you’ve seen through your work?

Inequitable access to skilled health personnel (health care workers trained to the required competencies to care for normal pregnancy, childbirth, identify and treat complications)

The global average of proportion of births attended by skilled health personnel is 81%, but in low-income countries, this is only 60% compared to 99% in high-income countries.

Inequitable access to caesarean sections: CS are life-saving surgical procedures required to manage obstetric and newborn complications. Women from richer households, who give birth in urban areas, private health facilities are more likely to have CS than those from poor households, those residents in rural areas or those who give birth in public facilities

Inappropriate use of caesarean section and risk of death from CS: In sub-Saharan Africa, one in 100 women who has a caesarean section will die - 100 times more than women in the UK. The outcomes for their babies are even worse, with eight per cent not surviving longer than a week. These figures indicate an increased risk of death due to poor standards of care in SSA compared to the UK.

What single action or change would make the largest contribution towards women surviving and thriving?

Improving access to quality antenatal, intrapartum and postpartum care including emergency obstetric care and family planning.

Financial barriers to access should be removed through universal health coverage, training of health care personnel, improved distribution and retention skilled health personnel and ensuring that health systems are adequately funded.

Why are the following complications so prevalent?

(Severe bleeding, infections, high blood pressure, Complications during delivery, Complications from miscarriage / abortion – all noted as the main complications leading to maternal mortality)

Inadequate number of health facilities that have capacity and resources to provide quality pre-natal, intrapartum care, emergency obstetric and newborn care and post-partum care including family planning (human resources, drugs, supplies, blood transfusion services, number of well-staffed facilities etc)

Communities and women of reproductive age have to be educated early recognition of pregnancy-related complications, acceptance of family planning and on the available medical resources accessible to them.

There need to be adequate investments in the health system so that health facilities are accessible to the community, these facilities are well-staffed and resourced. Systems are in place for continuous training of skilled health personnel to WHO standards and women should have ready access to the multidisciplinary team of medical personnel to manage these complications when they arise.

What are the skills that are typically lacking in LMICs that would help to reduce the maternal mortality ratio?

Poor funding and management of health systems

Poorly trained skilled health personnel

Lack of systems for continuous professional development for skilled health personnel

To reduce the rate of maternal mortality, to what extent is it more important to increase the number of healthcare professionals on the ground, or increase the skills and capacity that the existing providers have?

Both are essential to reduce the delays in accessing good quality care.

We need adequate training of new health care personnel, they need to be equitably deployed and retained. Then we need a system to ensure that there is continuous professional development, this will be useful in subsequent years but also for those currently in practice.