Persisting inequity in maternal health

Malin Bring

Inequities in access to essential health services, particularly reproductive health services and antenatal care, persist in all countries in the WHO European Region. In some of the poorest countries, for example, only 20% of the poorest women have access to at least 4 antenatal care visits during pregnancy, compared to over 80% of the richest women. In all countries, some groups of women are excluded from skilled birth attendance, owing to extreme poverty or discrimination.

Government officials, United Nations agencies and other partners from more than 25 countries met in Durres, Albania on 28–30 September 2010 to take stock of the Region’s progress towards achieving Millennium Development Goals (MDGs) 3–5, for promoting gender equality and empowering women, reducing child mortality and improving maternal health, respectively.

Interrelated MDGs

At the meeting, most countries reported that they are on track to achieve MDGs 4 and 5, but inequalities and inequities between and within countries persist. Progress has been made in reducing mortality in children aged under 5 years, but neonatal mortality remains a problem. The close links between the MDGs make achieving gender equality essential. Promoting girls’ education is a vital part of efforts to reduce child mortality, as deaths in children under 5 are directly linked to mothers’ level of education.
The link between early marriage and pregnancy complications gives another example of the links between the MDGs. Girls in several countries (including Azerbaijan, Ukraine, Albania, the Republic of Moldova and Tajikistan) may be married young. Early pregnancy increases the risk of complications and reduces the possibilities of spacing births (extending the intervals between them to maintain the mother’s health).

Member States reported that good policies are in place, but implementation and financing remain a challenge.

Looking beyond the numbers

Eliminating inequities in maternal health requires exploring the social, cultural and contextual reasons for the inequalities. The most recent edition of “Entre Nous”, the European magazine on sexual and reproductive health, explores how various countries throughout the Region are using the “Beyond the Numbers” tool developed by the WHO Making Pregnancy Safer programme.

Beyond the Numbers provides approaches for examining the background of maternal deaths and major complications and defining requirements for further improving the quality of care. These stories – reported through verbal autopsies, confidential inquiries, near-miss case reviews and case audits – provide social and cultural insights that number counting cannot.