Reports highlight threats to women’s health in poorest countries

By Barry Mason
11 May 2011

Two recent reports highlight the lack of health care provision affecting women in semi-colonial countries.

The first report is by the development charity Save the Children, entitled “Missing Midwives”.

Two of the Millennium goals (MDGs) set in 2000 were to reduce child mortality and to improve maternal health in the underdeveloped world. MDG4 was to reduce child deaths by two thirds by 2015, and MDG5 was to reduce maternal mortality by three quarters.

In September 2010, the United Nations launched the “Every Woman, Every Child” initiative to try to focus efforts to achieve the goals.

The Save the Children report shows these targets are unlikely to be met.

Giving birth without the assistance of a midwife or birth attendant is one of the main reasons for the tens of thousands of women and millions of babies who die as a result of childbirth. Save the Children notes in the foreword to the report: “It is unacceptable that women and their babies continue to die in childbirth in the 21st century because of a lack of access to midwives and other midwifery-skilled health workers.”

The figures revealed in the report are shocking: 48 million women a year give birth without the presence of someone with proper medical skills. Of these, 2 million give birth entirely alone. In Nigeria, one in five women give birth completely alone. This lack of medical assistance gives rise to 358,000 maternal deaths, the death of 814,000 babies during childbirth and around a million babies being stillborn who had been thriving up to point of birth.

The report notes that each year around 8 million children die before their fifth birthday, of which around 10 percent die during their first day of life, with 3 million not living beyond a month.

The report explains that midwives can help save lives at childbirth with interventions such as providing basic emergency obstetric care, making sure the baby is breathing well and kept warm and giving neonatal resuscitation to babies who are not breathing when they are born.

The three most common causes of deaths in newborn babies are complications arising from prematurity, such as underdeveloped lungs (28 percent), asphyxia resulting from lack of oxygen (23 percent) and sepsis—infection of the blood (15 percent).

The report estimates there is worldwide shortage of 350,000 midwives—part of a 3.5 million shortage of health care workers throughout the world needed to provide an adequate level of health care.

The report notes: “Every woman should have expert care and support when she gives birth. But the reality of childbirth for many women means delivering their babies at home with no midwife, lying on a dirty bed, or dirt floor in a house without running water, electricity or light.”

It gives figures for women giving birth without a midwife or skilled birth attendant. The average throughout the least developed world is 59 percent, in Ethiopia it is 94 percent and in Bangladesh 76 percent. This compares to the United Kingdom, where the figure is 1 percent.

A chart in the report shows a direct correlation between the percentage of births where there is attendance by skilled help and the number of babies dying in their first month of life. For countries such as the UK, with around 99 percent attendance, neonatal mortality is 1 in 200 or less. But in countries such as Chad or Afghanistan, with a 15 percent skilled-help attendance, the mortality rate is one in 20.

The report notes that plugging the 3.5-million gap in global health care workers would cost only around £30 billion.

It also points out: “When the International Monetary Fund (IMF) lends money to a country it often includes a requirement” for the country to “minimise the government deficit by restricting public spending.” This has the effect “of preventing countries from increasing the numbers of midwives and other health workers on the public payroll.”

Another report points to the growing number of women who are dying from cancer in poor countries, particularly breast cancer. Infectious diseases are a more common cause of death in poor countries, but cancer is becoming an increasing threat. According to the UN World Health Organisation’s (WHO’s) latest data, cancer was responsible for nearly 8 million deaths worldwide, 13 percent of all deaths in 2007. Of these, more than 70 percent occurred in low- and middle-income countries. It estimates deaths from cancer will reach 12 million by 2030.

The second report, carried in the April edition of the medical journal The Lancet, shows how the number of the cases of breast cancer in low- and middle-income countries is rising sharply.

The Lancet report was based on the Breast Health Global Initiative (BHGI) summit held in 2010. It points out that whilst in the richest countries income per head is around 100 times that in the most underdeveloped countries, spending on health care is 200 times greater. The Lancet comments: “With chronic diseases such as cancer, including breast cancer, the financial hardship of paying for health care could mean that patients and their families have to choose between health care and basic sustenance.”

The report notes that breast cancer is the most common form or cancer affecting women worldwide, with more than a million new cases each year, and that its incidence and mortality is expected to rise by 50 percent between 2002 and 2020. It notes, however, that “rising cancer rates will be greatest in developing countries, and are projected to reach a 55 percent increased incidence and 58 percent increased mortality in fewer than 20 years.”

The Lancet notes that in least-developed countries, there is “little public awareness of cancer generally, and breast cancer specifically”. It adds: “Breast cancer commonly remains undiagnosed until it is late stage or metastatic, when treatment options have less benefit or are simply unavailable.”

In economically emerging countries, the disease burden is beginning to shift from infectious diseases to chronic non-communicable diseases. Ben Anderson, one of the report’s authors, told the Huffington Post: “Global health care has largely focused on infectious diseases like malaria and TB, and of course they’re extremely important. But there’s a tsunami quality to this wave coming in breast cancer globally, and the systems haven’t been set up yet to address chronic care.”