Most Pregnancies Last 9 Months. Why Is the Deadliness of Childbirth Still Taking Us by Surprise?

Article by Anuradha Gupta, Deputy CEO of Gavi, the Vaccine Alliance

Measles, cholera, and diphtheria can kill quickly and without any warning. Yet with childbirth we get nine months’ notice, and it still kills more people every year than these three diseases combined.

It’s not just mothers either: 1 million children die every year before they are even one day old. While under-five mortality has halved since 1990, with immunisation being a strong contributor to the decline, we have not seen the same level of progress when it comes to neonatal mortality. Neonates now make up 50% of all the children who die before their fifth birthdays, with a large number of these deaths occurring in just three countries: India, Nigeria, and Pakistan.

The mortality rates of mothers and babies are more than just statistics — they are a litmus test for the state of health systems. With better medical care in the run-up to, during, and immediately after birth, the majority of these deaths could be prevented. Four-fifths of neonatal deaths are a result of premature birth, complications during delivery, or infections such as sepsis, meningitis, or pneumonia. For mothers, severe bleeding or infections after childbirth are the biggest killers. If nine months is not sufficient time for a health system to prepare for childbirth and mitigate these predictable risks, the system is unlikely to be well-placed to address more immediate threats to the communities that it serves.

A lot can be achieved with ante-natal care and increased numbers of facility births, as we have seen in recent years with the reduction of deaths from maternal and neonatal tetanus: one of the most common causes of death from unclean births. Three priority countries – Ethiopia, Haiti, and the Philippines – achieved tetanus elimination in 2017. This is largely thanks to high coverage with the tetanus vaccine, as well as the fact that more births are now taking place in hygienic, well-equipped facilities than ever before.

And vaccines do not just play a direct role in reducing maternal and neonatal deaths. They reach more than 90% of the world’s children, sometimes up to five times in the first year of life. This equates to at least 300 million points of contact a year, making them an invaluable platform for providing other life-saving health services to mothers and babies — from supporting the nutrition of women during pregnancy, informing women about the benefits of facility births, and monitoring the health of babies in the first few months of life. Harnessing this contact between young families and health systems to deliver a package of services is not just hugely impactful — it makes sound economic sense.

Beyond this, a more efficient, integrated approach to care delivery can help build more resilient health systems to face the global health threats of the future. Health systems that have seen years of improvement can rapidly crumble when faced with major unexpected challenges, as was seen in the wake of the Ebola epidemic in West Africa in 2014. In Liberia, facility-based deliveries and access to antenatal care had been improving prior to the outbreak, but once Ebola set in antenatal care declined by 50%. Deliveries by skilled birth attendants and facility-based births dropped by 32% and 35% respectively.

That’s why Gavi, the Vaccine Alliance, the organisation I work for, does more than just help countries gain access to more affordable vaccines. We invest in improving data, the supply chain, community engagement, and management of immunisation programmes.

But as we work to help countries build stronger health systems, we need to ask ourselves if they can truly be called strong if they are still unable to protect women and babies from these entirely preventable deaths.

Today on International Women’s Day, where this year’s focus is on striving to achieve gender balance, it is important to recognise an essential part of this is health equity. As we have seen with the tetanus vaccine, a small number of inexpensive but effective interventions can make a real difference. But for women, so long as the act of bringing life into this world means risking their own life, then there will always be more work to be done.

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