You may, from time to time, encounter articles in main stream media about healthcare injustices, but they are infrequent and often sensationalist in their purpose. Biases exist across our societies, and healthcare, which is reflective of the cultures in which it operates, mirrors these biases. Race, gender and financial standing impact care in many countries, the patient’s ability to access basic services and then, most tellingly, the levels and quality of care that is dispensed to these populations.
If we can make maternal deaths as rare as they are in the healthiest countries we can save almost 300,000 mothers each year
Figures from ourworldindata.org
If you are a woman, you are going to struggle to access unbiased levels of care. If you are woman who is Black, Brown Asian, Indian or any dark skinned complexion, and poor to boot, you are really going to struggle to access any form of care. If you are unfortunate enough to live in areas where these biases or prejudices are marked, you could end up paying for this discrimination with your life.
Another often unappreciated factor in the delivery of care to women is their physiology. Women get the short end of the stick, biologically speaking, when it comes to developing conditions that require medical interventions. The ability to create life comes at a price. The female body requires preventative care from a young age, for instance the HPV vaccine, administered to young girls to prevent cervical cancers later in life.
A woman’s womb exposes her to real healthcare challenges that often require invasive, expensive and technically challenging procedures. Procedures that rely on hospitals and clinics to provide the infrastructure and qualified providers to provide the skills. In some countries, facilities are often lacking and in certain more rural location, both are absent.
The main direct causes of maternal death are severe bleeding, unsafe abortion, infection, eclampsia, and obstructed labor; the indirect causes include anemia, malaria, heart disease, and HIV. Pregnancy complications are the main cause of death for women aged 15-19. Access to proper care can dramtically impact these figures. Risks of poor outcomes during pregnancy and childbirth are exacerbated by poverty, low status of women, lack of education, poor nutrition, heavy workloads and violence.
Then there is the issue of unsafe abortions. Around 73 million induced abortions take place worldwide each year. Six out of 10 (61%) of all unintended pregnancies, and 3 out of 10 (29%) of all pregnancies, end in induced abortion. The World Health Organization estimates that 30 women die for every 100,000 unsafe abortions in developed regions, while 220 women die for every 100,000 unsafe abortions in developing regions,
It’s unacceptable that a woman in Sierra Leone is 300 to 400 times more likely to die during pregnancy or childbirth than a woman in Sweden or Finland, and we know it is possible to prevent these deaths.
In more advanced societies, the issue of accessing care is often reduced to one simple determining factor. Money. Countries like America have healthcare systems that are beleaguered by profiteering and it is a trend that is being mirrored in more and more first world world countries. Healthcare again, reflects societies that are turning their backs on disadvantaged communities. Poverty breeds indifference. Indifference that is fatal to many women and, by association, their newborn.
Infant Mortality: 18 deaths per 1,000 live births in 2021
UNICEF Data
The first 28 days of life – the neonatal period – is the most vulnerable time for a child’s survival. Children face the highest risk of dying in their first month of life at an average global rate of 18 deaths per 1,000 live births in 2021, down by 51 per cent from 37 deaths per 1,000 live births in 1990, but figures have been impacted again by the pandemic and figures, not yet released, reflect a worrying increase.
Maternal Mortality: 223 deaths per 100,000 live births
UNICEF Data
Maternal mortality refers to deaths due to complications from pregnancy or childbirth. From 2000 to 2020, the global maternal mortality ratio (MMR) declined by 34 per cent – from 342 deaths to 223 deaths per 100,000 live births, according to UN inter-agency estimates. It is widely accepted that these figures are underreported, with deaths occurring in isolated, remote areas, not accounted for.
Every 16 seconds, a baby dies. Every 2 minutes a pregnant mother dies
To put the problem into context, a few additional figures.
The UN estimates that around 385,000 babies are born each day around the world (140 million a year). This number will remain relatively stable in the 50 years from 2020 to 2070. From 2070 to 2100, the number will decline to around 356,000 (130 million a year). The five countries with the highest number of maternal deaths in 2017 were: Nigeria (67,000); India (35,000); Democratic Republic of Congo (16,000); Ethiopia (14,000); and Tanzania (11,000).
Of course, the chances that a woman dies from maternal causes are not only dependent on the risk per pregnancy – which the graph above shows – but also the number of pregnancies she has.
The average woman in the UK or Sweden has one or two children. In Niger, she has seven children. Not only is the risk per pregnancy higher at lower incomes, but also the number of births. Maternal mortality rates tend to be higher where women have more children. These amplify the differences in risk between high and low-income countries.
In 2020 in the U.S., the maternal mortality rate for non-Hispanic Black women was 55.3 deaths per 100,000 live births, 2.9 times the rate for non-Hispanic White women. Rates for non-Hispanic Black women were significantly higher than rates for non-Hispanic White and Hispanic women. The increases from 2019 to 2020 for non-Hispanic Black and Hispanic women were significant.
The CDC lists the following four roadblocks to improving maternal care in the U.S.
- Eliminate racial and ethnic disparities in maternal mortality.
- Invest in and partner with communities.
- Ensure access to care for all pregnant and postpartum persons.
- Ensure quality care for all pregnant and postpartum persons
Admirable goals, but with no clearly defined plan of action in place, articles like these are merely pandering to a patient population that, according to the CDC and others, needs to restructure the very fabric of the societies they live in to access meaningful care. It’s a common refrain, sung by the WHO and many other global health bodies and it is a cop-out of monumental proportions.
It takes generations to engender change in a society and these changes can be ephemeral, here today, gone tomorrow. Take abortion and a woman’s right to choice. Society is not where we look to resolve healthcare’s biases.
There are simple, actionable solutions to address the healthcare issues faced by women, and they all begin at the door of healthcare itself. Read this follow up article to understand how the Clinics IV Life model seeks to improve access to care for disenfranchised and disadvantaged communities across the globe. While we most certainly don’t have all the answers, we are implementing workable solutions that have an immediate and positive impact on the health outcomes of these vulnerable communities.
None of us can afford any longer to be spectators to one of healthcare’s most damning indictments.