Maternal health in the next 20 years will be transformed by social, political, environmental, and demographic changes. The context of women’s lives will change because of urbanisation, greater access to information, and rising expectations for good quality, woman-centred care.
Low- and middle-income countries’ health systems frequently struggle: they often have no money, very few staff with low skill levels, and weak management and governance.
When shocks hit—like disease outbreaks, armed conflict and natural disasters—there is greater demand for care and these fragile systems struggle to respond, and ultimately collapse.
Emergencies increase the number of patients while at the same time decreasing the system’s ability to care for them due to dead or injured health workers, damaged facilities, and disrupted electricity, water, sanitation and supplies. Pregnant women and children are often disproportionately affected.
All these shocks also cause population displacement and migration. Pregnant women and women of reproductive age often suffer during the movement process, even after resettling.
To resist crises countries must make their health systems more resilient, so they can care for crisis victims while meeting routine health needs like maternal and newborn care.
More people now live in cities than outside them: by 2050, 60% of births will be in urban areas. The rich-poor gap in access in urban areas is wide, sometimes bigger than the gap in rural areas. Rural families moving to cities often move to slums or informal settlements, where they face many new issues and barriers to maternal healthcare.
Increasing urbanisation means that the proportions of populations covered by health services will increase, so countries need to think more about how to ensure good quality care. Research is urgently needed on how best to care for poor women in urban areas. New ideas are emerging: in South Africa, extra alongside midwifery-led units have been introduced at hospitals; and in Bangladesh, a non-governmental organisation was designed to help urban pregnant women get good quality care.
Armed conflict affected about 1.2 billion people in 2015. Conflict causes injury, psychological damage and death to civilians, and increases vulnerability and inequality. Because of insecurity and the destruction of basic health infrastructure, conflict also limits access to maternal and reproductive health services, in addition to others.
During times of conflict and recovery from conflict, countries tend to see an increase in pregnancies, births and maternal deaths. One study showed that sub-Saharan African countries that had experienced recent armed conflict had maternal death ratios 45% higher than those countries without recent conflict.
Climate change, environmental degradation and natural disasters affect human health and wellbeing, but they affect women’s health, rights, and roles worst of all—for example, because increased time spent collecting fuel and water takes a physical and mental toll and diverts women’s time away from other things, including looking after their health.
Overall levels of development assistance for health (external money given to developing countries to spend on health) have levelled out at about US$30 billion every year. Within this, though, the amount spent on reproductive, maternal, newborn, child and adolescent health crept upward between 2008 and 2012.
It is possible that more such money could become available after the recent launch of the Global Financing Facility, a project that aims to raise more than US$57 billion for this area between 2015 and 2030. The Global Financing Facility aims to do this by catalyising collective action, increasing efficiency, and bringing together funding from domestic and international partners. However, it seems certain that money from donors will continue to decline overall. Countries will need to increase the money they spend from their own budgets.