No help during childbirth and no assistance with complications afterwards; these women are the poorest of the poor. They have no access to transport, money, health facilities, medical care, and support to enable them make and put into action the right decisions.
Yes. Births in facilities, with skilled birth attendants, are increasing worldwide. The same is true for ANC and family planning. In theory this should reduce deaths in and around childbirth and improve wellbeing for mothers and babies.
But progress is not as great as expected. Phrases like “skilled birth attendant” and “emergency obstetric care” do not guarantee quality care, or care that can be accessed quickly enough. The gap between countries with highest and lowest mortality has increased, showing an important and unfair gap in quality of care. In many parts of the world women receive delayed, inadequate, unnecessary, or even harmful interventions. Opportunities for improved health for mothers and babies are being missed.
In seven sub-Saharan African countries studied, four had more than two-thirds of facility births in sites that lacked three elements of basic infrastructure, like water or electricity, crucial to safe delivery. More than half of facility births were in sites that could not provide basic emergency obstetric care.
Maternal care in facilities should be dignified and respectful. “Respectful maternity care” means the right clinical interventions, given at the right time, with respect for individual, cultural, personal, and medical needs. This allows women to maintain dignity and control.
Providing this kind of care also means respecting and supporting healthcare workers as well as women and families, so that they are equipped and ready to provide good care. This must be part of countries’ health facilities, systems and guidelines.
Respectful care means women can be looked after continuously, and receive individualised, culturally and contextually appropriate care. It means that they can have any birth companion they want—even this simple right is often denied by health care systems that do not allow women basic choices. Finally, it means that all women are treated with respect, given the information they need, and given opportunities and resources to make decisions about their own care.
While respectful care is the goal, work must be done to ensure women can access that care. In many countries, poverty and a lack of infrastructure combine to prevent any access at all. National health plans must make sure that women, especially the most vulnerable, can reach good quality birth services when they need to. To achieve this we need better information and better understanding of how women currently use transport to access maternity care, and how they move in preparation for birth.
To meet the SDGs, the world needs more than 18 million additional health workers by 2030. The current gap is enormous: sub-Saharan African countries with the largest numbers of births (such as Democratic Republic of the Congo, Tanzania, Kenya, and Ethiopia) have fewer than two midwives and obstetricians per 1,000 pregnancies.
There are significant inequalities within countries, with the standard of care and the levels of maternal illness and death varying greatly even within single cities. Even within high-income countries, where most people can access good services, many disadvantaged and vulnerable groups still suffer. For example, black women in New York City are more likely to die in childbirth than women in middle-income countries such as Vietnam.
Migrants are a particularly vulnerable group. According to UNHCR figures, there are now more than 65 million forcibly displaced people worldwide. With the numbers of refugees around the world increasing to levels never seen before, this is a pressing concern.