How can child and maternal mortality be cut?BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c431 (Published 26 January 2010) Cite this as: BMJ 2010;340:c431
All rapid responses
I congratulate Tatum Anderson on her excellent article “How can child
and maternal mortality be cut?” (BMJ 30 January, which clearly sets out
the major obstacles to achieving maternal and newborn health and
sufficient mortality reductions to meet the Millennium Development Goals
However, there is a significant omission in this coverage as the
demand side issues, which are widely acknowledged to be part of the
problem, were not addressed. The World Bank, for example, in
documentation around the current review of its Reproductive Health
strategy, notes that low demand for reproductive health services (which
include maternal health services) is a constraint in achieving good
reproductive health outcomes.
Work with communities is vital to reduce two of the three delays
which contribute to maternal and newborn mortality and morbidity – namely
delay in deciding to access skilled healthcare and delay in reaching a
health facility. Factors contributing to this are numerous and include
household decision-makers (husbands and mothers-in-law) not prioritising
the health of women and newborns, health care fees, the distance to be
traveled and costs incurred in reaching health facility, and lack of
knowledge and awareness of what constitutes a health emergency, and even
good, basic care, for pregnant women and newborns.
These issues must be addressed at community level and this is often
best done by civil society organisations. Women and Children First UK
(www.wcf-uk.org) works with partners in Asia and Africa, applying a tried
and tested community mobilisation approach focused on women’s groups which
empowers women to increase their knowledge of best practice for maternal
and newborn health and act on this knowledge, while at the same time
involving the wider community to improve care and reduce the three delays.
The approach, trialled in the Makwanpur District of Malawi, has
demonstrated a 30% reduction in newborn mortality and a notable reduction
in maternal mortality. (Effect of a Participatory Intervention with
Women’s Groups on Birth Outcomes in Nepal: Cluster-randomised controlled
trial. By Manandhar et al. Lancet 2004; 364: 970-979). We believe that
without increased attention being paid to, and support provided for,
demand side action, the MDGs on reducing maternal mortality and increasing
child survival will not be met and 5 million lives a year will continue to
be lost needlessly.
Competing interests: No competing interests
Maternal mortality issue has troubled each and every individual
caring the pregnant women. Each meeting has addressed this issue again and
again. By this time we have partly realised what should be done.
Awareness, availability of trained birth attendant, provision of emergency
obstetric care, organised referral system with proper transport facilities
will tackle the issue to a great deal. Mr Anderson has written this
article with a deep understanding of this issue1. He is absolutely right
to point out that reduction of maternal mortality is not just an academic
issue but more of a political issue. India, in spite being the world’s
fourth largest economy is struggling because of several reasons.
awareness about the benefit of delivery at an appropriate set up by a
trained birth attendant is still low.
Secondly, in spite of great deal of
enthusiasm from the central government, implementation at the ground level
is very variable.
Thirdly, overall availability of health care personnel
at the ground level is hampered by slow overall development of the rural
Fourthly, although there is a significant development in roadways
and communication in last decade; a large area of the country still lacks
in appropriate transport facilities particularly at the time of need.
Fifthly, improper distribution of funds leading to purchase of
inappropriate gadgets in inappropriate places also is draining the money.
Sixthly, nearly two decades ago during our maternal mortality inquiry in
rural India we realised that problem should be addressed from two sides –
training the traditional birth attendants from one side and making the
rural service more attractive to the fresh graduates2.
Lastly, we all
understand that any developing economy will have corruption associated
with it; but the corruption at every level is one of the main reasons for
the poor implementation in spite of the good intentions particularly in
1. Anderson T. How can child and maternal mortality be cut? BMJ 2010;
2. Kumar R, Sharma A, Barik S, Kumar V. Maternal mortality inquiry in a
rural community of North India. Int J Gynecol Obstet 1989; 29:313-9.
Competing interests: No competing interests