We Cannot Tackle Maternal Mortality Without Surgical, Obstetric, and Anesthesia Care

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 rates of maternal mortality are increasing globally, and, at the rate we are currently, it is unlikely that we can meet the United Nations’ SDG goal for the reduction of MMR until 2030. The discussion on MMR is not complete without mentioning the vital, but often under-appreciated importance of surgical, obstetric as well as anesthesia (SOA) medical care. Two examples that are essential to reduce MMR include the optimal Caesarean section rates and a sufficient SOA workforce availability. However, the most important global indicators for surgery are missing from SDGs.

In the past, it was reported that the WHO stated that a C-section rate that was higher than 10 percent of live births within an entire year did not help reduce the mortality rate of mothers. Recently the WHO has found that an increase of 19 percent C-section rate is found to be linked with MMR reductions. For large LMICs, such as India, states that have C-section rates of 10% see significant reductions in MMR.

Additionally, There are a number of large LMICs which require scaling up C-sections. In low-income countries, having an adequate rate of C-sections could cut down on more than 60% of the mortality rate for mothers. For the most affluent LMICs, excessive out-of-pocket expenditures can also be a hindrance to accessing C-sections, leading to an increase in 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 that are not indicated have been linked with more than three times the risk of mortality among mothers than normal deliveries. They also eat up precious resources of the health system, including finance, obstetricians, anesthetists, radiologists, and anesthetists, and are desperately needed across the world. It is essential to reduce the mortality of mothers. Intensifying C-section delivery and various SOA options at the second stage of care and in facilities that are capable of handling complications is essential for reducing accessibility disparities in the largest LMICs.

To enhance C-section care, However, the LMICs require specialists with more experience. The research conducted by the Lancet Commission on Global Surgery found the fact that having at minimum twenty SOA specialist per 100,000 is associated with significant decreases in MMR. In the average, countries with low incomes contain 0.7 SOA specialists per 100,000 people, while middle-income areas contain 5.5 SOA specialists per 100,000 people. That 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 specialists such as nurse anesthetists, nurse surgeons, and midwives, along with other professionals, are also contributing to the high rate of MMR. The capacity to train and task-shifting, task-sharing and team-building are essential. For example, countries with undergraduate medical programs (e.g., India, Brazil, Tanzania, etc.) could benefit from competency-based education on basic surgical. In addition, interventions to promote SOA specialization and retain in rural areas are essential to reduce the MMR. The focus should be placed on creating SOA specialists accessible at lower levels of administration, such as districts.

The absence from global surgical indicators during the millennium and sustainable development goals reveals an indifference to the contribution made by SOA medical care towards MMR reductions. Future discussions, as well as policies and investments, must rectify this.

Siddhesh Zadey B.S.M.S MScGH is an academic researcher at GEMINI Research Center, Duke University School of Medicine located in Durham, North Carolina, and co-founded the Association for Socially Applicable Research (ASAR) an non-profit, non-governmental think and do research institute located in India.

Nachiket Professor Mor, Ph.D. is an invited researcher at the Banyan Academy of Leadership in Mental Health in India.

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