The next week, the delegates of the UN General Assembly in New York will reflect on the progress made at the halfway point of sustainable development objectives timetable. In the ranks of those who advocate for “health for all,” the issue of maternal mortality will be one of the most pressing issues. The rate of maternal mortality is increasing across the globe, and, at the rate we are currently, we will not be able to meet the goal of the UN’s SDG goal for reduction in MMR in 2030. In addition, the discussion about MMR is not complete without mentioning the vital, but often under-appreciated importance of surgical, obstetric as well as anesthesia (SOA) treatment. Two prominent examples essential to reduce MMR include the optimal Caesarean section rates as well as sufficient SOA workforce availability. Nevertheless, the global surgical indicators are shockingly missing from SDGs.
In the past, WHO observed that a C-section rate that was higher than 10 percent of live births within one year did not help reduce the mortality rate of mothers. In the last few years it was discovered that an increase of C-section rate of 19% is found to be linked with reductions in MMR. Within large LMICs, such as India states, those with rates of less than 10% have significant MMR reductions.
Additionally there are many large LMICs which require scaling up C-sections. In low-income countries, having the right C-section rate could cut down on more than 60% of the mortality rate for mothers. For larger LMICs, excessive out-of-pocket expenditures can also be a hindrance to accessing C-sections, leading to a high rate of MMR. On the other hand, several upper-middle-income countries–particularly in their private health sectors–need interventions to scale down excess C-section rates. C-sections with no indication have been associated with more than three times the risk of mortality among mothers than normal deliveries. They also consume the health system’s resources, like obstetricians, finance anesthetists, radiologists, and other doctors that are needed urgently everywhere in the country. It is essential to reduce the mortality of mothers. The strengthening of C-section delivery as well as the other SOA support services in the second stage of care with facilities capable of handling complications is essential for reducing the disparities in access to care in large LMICs.
In order to improve the quality of C-sections However, the LMICs require specialists with more experience. The study conducted by the Lancet Commission on Global Surgery discovered it was found that having at minimum twenty SOA specialist per 100,000 is associated with significant cuts in MMR. On average, low-income nations contain 0.7 SOA specialists per 100,000 people, while middle-income nations contain 5.5 SOA specialists per 100,000 people. This means that more than 120 countries must scale up SOA specialists in order to decrease MMR. Beyond specialists, the shortage of specialists and a disproportionate distribution of allied professionals, such as nurse anesthetists, nurse surgeons and midwives, among others, contribute to the high rate of MMR. Training capacity improvements as well as task-shifting, sharing of tasks, and team efficiency are required. For example, countries that have medical schools that offer undergraduate level courses (e.g., India, Brazil, Tanzania, etc.) are able to benefit from competency-based instruction for basic surgical. Furthermore, policies that encourage SOA specialists’ recruitment and retention in rural areas are essential to reducing MMR. The emphasis should be placed on creating SOA specialists accessible at lower levels of administrative authority, similar to districts.
The absence of global surgical indicators in the millennium, as well as sustainable development goals, reveals an indifference to the contribution made by SOA medical care towards MMR reductions. Future discussions, policies, investments, and discussions must rectify this.
Siddhesh Zadey, BSMS MScGH is an investigator at the GEMINI Research Center, Duke University School of Medicine located in Durham, North Carolina, and is a co-founder of the Association for Socially Applicable Research (ASAR) an non-governmental, non-profit think and do tank based in India.
Nachiket Professor Mor, Ph.D. is an invited research scientist from the Banyan Academy of Leadership in Mental Health in India.
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