Maternal Mortality in Central America: The Need to Accelerate Efforts by 2035
As we approach the 2015 deadline for the Millennium Development Goals, what does the future hold for international maternal mortality targets? The MHTF is pleased to be hosting a blog series on post-2015 maternal mortality goal setting. Over the next several weeks, we will be featuring responses and reactions to proposed targets from around the world. Please share your thoughts with us!
Between 1990 and 2010, maternal mortality decreased in Latin American countries and the Caribbean by nearly 44%, from 14,529 maternal deaths per year to 8,141. That corresponds with a reduction in the maternal mortality ratio (MMR) from 125 to 75 deaths per 100,00 live births. However, none of the Latin American countries will reach the MDG 5 target for maternal mortality. Some actions have been made to achieve these accomplishments such as the growing of institutionalization of deliveries, the increase personnel in trained to provide care during childbirth and emergency obstetric care.
The maternal health situation varies among less developed Central American countries: Honduras has an MMR of 73 deaths per 100,000 live births, Nicaragua’s MMR is 75, El Salvador’s is 85 and Guatemala’s is 153. Progress toward improving maternal health has also varied: starting in 1990, Honduras had the highest percentage (65%) reduction, followed by Nicaragua (49%) and El Salvador (40%) – all above the figures for Latin American countries overall. Among this group, Guatemala is the only country that has not implemented any new intervention during this period. However, none of the Central American countries will reach the MDG 5 target to decrease Maternal Mortality.
What is the future situation for these countries? Without a doubt, the Millennium Declaration’s attention to the greatest problems of inequality in global health, poverty and inequities in development; and the establishment of the MDGs that followed have moved the majority of governments of least developed countries to action. However, to date, the efforts have not been enough. There is a need to rethink actions that have enabled an effective reduction, as well as rethink a new goal and target in the future. Regardless, the effort needs to be focus the mainly among the marginalized and poor, which frequently reside in remote and rural areas with limited access to health care services.
There is a call to move to new strategies to help to achieve rapid reductions in maternal mortality. Multiple interventions are better than a single intervention to address more that the clinical causes of maternal death. Preliminary results for our study were reported last year in ”A matched pair cluster randomized implementation trial to measure the effectiveness of an intervention package aiming to decrease perinatal mortality and increase institution-based obstetric care among indigenous women in Guatemala” in BMC Pregnancy and Childbirth. This showed remarkable results, and we will implement the intervention package at scale in 2014. This package includes: a low cost simulation-based training program using low-tech birth simulator to teach provider teams emergency management during childbirth; a research-driven social marketing campaign encouraging women to give birth in clinics rather than at home; and professional midwife liaisons charged with connecting traditional birth attendants to the formal health care system. We expect this effort will catalyze critical practice change in maternal and newborn care and increase the proportion of birth attended in clinics, thereby saving mothers´ and newborns´ lives in indigenous communities.
Without a doubt, accelerating the reduction of maternal mortality in Central America will require rapid scale-up of interventions and focused attention on maternal mortality well beyond the MDG 5 deadline of 2015.
If you would like to submit a guest post for to our ongoing series exploring potential goals for maternal health in the post-MDG development agenda, please contact Andrea Goetschius: goetschi@hsph.harvard.edu