Women's health : The childbearing years and after

Introduction

Each year more than 150 million women become pregnant, and more than 15%—23 million women—develop complications needing skilled treatment.1 Each year, over half a million women die from causes related to pregnancy and childbirth.2 The risk of dying varies from country to country: the lifetime risk of dying from causes related to pregnancy and childbirth in Africa is 1 in 23, compared with 1 in 4000 in North America.3

The risks of childbirth are higher when there are other health problems such as high blood pressure, heart disease, malaria, and diabetes. Pregnancy also carries a higher risk for relatively young and old women and for women who have many babies in a short space of time.

Improving the health of pregnant women

The dramatic falls in maternal mortality in developed countries over the past 100 years have largely been attributed to the move towards having babies in hospital.4 But women have been increasingly unhappy with the medicalisation of childbirth. In response to this, the British government set up the Cumberledge Committee, which reported in 1993. The committee found no evidence to support the medical paradigm for maternity care for most women and recommended that all the care for pregnant women should be provided by midwives.

Most of the deaths from causes related to pregnancy and childbirth occur in the developing world, and almost all of these deaths are preventable with existing knowledge and technology. In response to this challenge, the international health community, including the World Bank, the World Health Organisation, the United Nations Population Fund, and agencies in 45 countries, launched the Safe Motherhood Initiative in 1987. The initiative aimed to halve the number of maternal deaths by the year 2000 by providing programmes focusing on the provision of services in three areas:

• Information and education, designed to create demand for …