Maternal Health and Education

Education is important for everyone, but it is especially significant for girls and women. If educated, girls and women marry later, postpone childbearing, have fewer children and are better able to take timely decision about accessing health care services.[i]

Women's low educational levels have been found to be associated with a higher risk of maternal death,[ii] as there is a negative relationship between low levels of maternal education and health service use.[iii] 

Furthermore, the lack of education is highlighted as one of a number of stressors (along with limited money and decision-making power) affecting women during pregnancy and childbirth, creating vulnerability and increasing the likelihood of negative outcomes.[iv]

In fact, a study of 287,035 women who gave birth in health care institutions in 24 different countries found that the risk of maternal mortality decreases with each increase in educational level,[v] as depicted in the below table.

Table 1: Distribution of maternal deaths by years of maternal education.

Data source: Karlsen et al. BMC Public Health 2011 11:606 

The study demonstrated that the higher mortality of women with lower levels of education could not be explained by the level of services available at the institution where they gave birth. Maternal age, marital status, parity and level of state investment in health services obviously had a significant impact on the maternal mortality rates, however, even when the study was adjusted for maternal age, marital status, parity and level of state investment in health services - there was a clear link between the level of maternal education and mortality. Even for women able to access facilities providing intrapartum care, the link between that of education level and mortality remained.[vi]

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[i] World Health Organisation (2013), 'Women's Empowerment and Gender Equality.' (New York, WHO Press)

[ii] Shen C, Williamson JB, 'Maternal mortality, women's status, and economic dependency in less developed countries: a cross-national analysis.' Social Science & Medicine 1999, 49(2):197-214.

[iii] Thaddeus S, Maine D, 'Too far to walk: maternal mortality in context.' Social Science and Medicine 1994, 38(8):1091-1110

[iv] Filippi V, Ronsmans C, Campbell OMR, Graham WJ, Mills A, Borghi J, Koblinsky M, Osrin D, 'Maternal health in poor countries: the broader context and a call for action.' Lancet 2006, 368:1535-1541

[v] Karlsen S, 'The Relationship between Maternal Education and Mortality among Women giving Birth in Health Care Institutions.' BMC Public Health. 2012. 11:606.

[vi] IBID.

Maternal Health

Maternal health refers to the health of women during pregnancy, childbirth and the postpartum period. While motherhood is often a positive and fulfilling experience, for far too many women it is associated with suffering, ill-health and even death.[i]

In 2014 about 800 women died due to complications of pregnancy and child birth every day. Almost all of these deaths have occurred in low-resource settings, even though most could have been prevented.[ii]

Photo: Katrine Nohr

The high number of maternal deaths in some areas of the world reflects inequities in access to health services, and highlights the gap between rich and poor. A high number of maternal deaths occur in developing countries. More than half of these deaths occur in sub-Saharan Africa and almost one third occur in South Asia.[iii]

The maternal mortality ratio in developing countries is 230 per 100 000 live births versus 16 per 100 000 live births in developed countries. There are large disparities between countries, with few countries having extremely high maternal mortality ratios around 1000 per 100 000 live births.

There are also large disparities within countries, between women with high and low income and between women living in rural and urban areas. However, the risk of maternal mortality is highest for adolescent girls under 15 years and complications in pregnancy and childbirth are the leading cause of death among adolescent girls in developing countries.[iv]

The major complications that account for nearly 75% of all maternal deaths are:

·       severe bleeding (mostly bleeding after childbirth)

·       infections (usually after childbirth)

·       high blood pressure during pregnancy (pre-eclampsia and eclampsia)

·       complications from delivery

·       unsafe abortion.

Most of these complications develop during pregnancy. Other complications may exist before pregnancy but are worsened during pregnancy.[v]

Most maternal deaths are preventable. All women need access to antenatal care in pregnancy, skilled care during childbirth, and care and support in the weeks after childbirth. It is particularly important that all births are attended by skilled health professionals, as timely management and treatment can make the difference between life and death.

Maternal health has traditionally been understood from a predominantly medical perspective until research revealed that structural constraints/ human rights issues play a part, as these might prevent or delay women from being able to access high quality maternal health care. There are three main delays that might occur:

The first delay might be on the part of the women herself, the family, or community not recognizing a life-threatening condition. Births might take place at home with unskilled birth attendants, who might not have the skills to predict severe outcomes or the medical knowledge to diagnose and immediately act on complications. By the time the unskilled birth attendants or family realizes there is a problem, it may be too late for the women to reach an appropriate healthcare facility.

The second delay is in reaching a healthcare facility, which may be due to road conditions, lack of transportation, or rural location. Many villages do not have access to paved roads and many families do not have access to vehicles. Public transportation may be the main transportation method, even if this means that it may take hours or days to reach a health-care facility. Women with life-threatening conditions might thus not make it to the facility in time.

The third delay occurs at the healthcare facility. Upon arrival, women might receive inadequate care or inefficient treatment. Resource-poor healthcare facilities may not have the technology or services necessary to provide critical care to haemorrhaging, infected, or seizing patients. Omissions in treatment, incorrect treatment, and a lack of supplies contribute to maternal mortality.[vi]

If we are aware that the above mentioned factors results in delays in 1) deciding to seek care, 2) delays in reaching care in time, and 3) delays in receiving adequate treatment, the question remains how we can make sure that women can overcome these? 

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[i] World Health Organisation, 'World Health Report 2014' (2014) 

[ii] World Health Organisation, 'World Health Statistics 2014' (2014) 

[iii] World Health Organisation, 'Maternal Mortality Fact Sheet No 348' (2013)

[iv] Patton GC, Coffey C, Sawyer SM, Viner RM, Haller DM, Bose K, Vos T, Ferguson J, Mathers CD, 'Global patterns of mortality in young people: a systematic analysis of population health data.' Lancet, 2009, 374:881–892

[v] Say L et al., 'Global Causes of Maternal Death: A WHO Systematic Analysis.' Lancet. 2013.

[vi] Nour N, 'An Introduction to Maternal Mortality.' Obstetrics and Genecology, 2008, Spring; 1(2) 77-81