Director, Averting Maternal Death and Disability Program Columbia University Mailman School of Public Health
TBAs, traditional birth attendants, assist and help women delivering at home, most of all when they don’t have money required for health facilities, when they live far from hospitals, but also because sometime health workers treat women in a rude way so pregnant women prefer and feel more comfortable using the support of a TBA. Photograph by Paolo Patruno.
Inequality seems to be a strong demarcating line of the disparity between women receiving antenatal care and skilled support during delivery, and those who don’t.
“The main goal [in the fight against maternal mortality] is that all women, including the marginalized, can get access to services,” said Professor Lynn P. Freedman. “We as a world health community know what technological interventions are required to avert virtually all these deaths. It’s not a big technological challenge: it’s about the inequity in the access and utilization of services.”
The Director of the Averting Maternal Death and Disability Program at the Columbia University Mailman School of Public Health and former senior adviser to the UN Millennium Project Task Force on Child Health and Maternal Health, Freedman argues that the challenges to maternal health are of a tripartite nature: on one hand there are macro-level factors, such as poverty or geographic location; on the other, there’s a reality of poorly functioning systems, and lastly there are individual choices – themselves constrained by the socio-political context.
Freedman reported that in Ethiopia, for instance, the institutional delivery rate is extremely low: only six percent of women give birth in facilities, which means that most of the births (as well as the deaths,) happen in people’s homes.
“We need to get women in hospitals,” she said. “But we also need functioning facilities.”
While many challenges to maternal health can’t be prevented but can at least be treated in emergency care, the situation regarding newborn health is more complex. Poor sanitary standards at delivery are one of the largest causes of death for newborns, but families’ behavior also plays a crucial role in fostering the health of children after birth ‑ hence the need for resources and for a culture towards a continuum of care, from home to the hospital and then back into people’s homes.
“Maternal health is not only a technical issue, it’s profoundly a human rights issue,” Freedman said. “People should be able to exercise their choices and rights – and they should have the information and the means to do it.”