As we enter the post-MDG world, with the newly-drafted Sustainable Development Goals in hand, the recent launch of the Strategies toward Ending Preventable Maternal Mortality (EPMM) strategy paper at the World Health Assembly is an important moment for the maternal health and global health communities.
The EPMM paper lays out five strategic objectives to guide programs working toward EPMM, as well as several cross-cutting actions that support this goal. It is important to remember that many averted maternal deaths may still result in maternal morbidity, including severe and/or chronic conditions. The Fistula Care Plus (FC+) Project at EngenderHealth works to help prevent and treat some of the most serious maternal morbidities, including obstetric fistula and pelvic organ prolapse (POP). A few thoughts upon considering the EPMM strategy from the perspective of maternal morbidity reduction and the work of the FC+ project:
- One of the cross-cutting actions identified in the EPMM report is improving metrics, measurement systems and data quality. The report highlights the urgent need to strengthen vital registration systems and count all births and deaths. Deaths are an essential metric, but it is also crucial for health systems and global actors to carefully track morbidity, including complications, infections, and iatrogenic injuries. These are very important indicators of the performance of health services – as more women make the choice to deliver at health facilities, we must ensure that the services they receive are respectful, safe, and of the highest possible quality. Additionally, good measurement of morbidities is necessary for appropriation allocation of resources and planning and organization of health services that prevent and treat these conditions.
- The strategic objectives identified in the EPMM paper are also at the heart of any effort to prevent and treat obstetric fistula. Obstetric fistula should be seen as a ‘sentinel event’ – its occurrence is evidence that the community and health system have failed to deliver access to timely, quality maternal health services. It is the poorest and most rural who are most vulnerable to fistula and other adverse outcomes of obstructed labor. The EPMM strategies of promoting universal health care coverage and addressing inequities in health care access and quality (Strategic Objective 1 and 2) target these very vulnerabilities.
- Despite these commonalities, a morbidity perspective may suggest additional strategies and priorities beyond those driven by mortality reduction. For example, while obstructed labor may not contribute directly to a large percentage of maternal deaths, it is responsible for a huge proportion of emergency obstetric and newborn care. C-sections account for a large proportion of the total surgical need and services at many hospitals in developing countries, and capacity to provide safe C-sections must expand dramatically to meet the needs of women in South Asia and sub-Saharan Asia. Therefore, a morbidity lens must accompany the mortality focus, to ensure that programs are designed with population and health system needs in mind. It is heartening to see that the EPMM paper recognizes disabilities at the strategic level (Strategic Objective 3).
We at FC+ congratulate the EPMM team on the launch of this important paper. In partnership with governments, health systems, and partners in the maternal health community, we look forward to working towards ending preventable maternal deaths and also radically reducing preventable maternal morbidity.