Despite improvements in health care, almost 300,000 women, primarily in developing countries, died from complications related to pregnancy and childbirth in 2013, according to a new report that attributes the deaths to a lack of safe water, sanitation and adequate hygiene.
A paper published in the journal PLOS Medicine reports that some 38 percent of healthcare facilities in 54 developing countries continue to lack proper sanitation and a source of clean water, putting women who give birth there at increased risk of death.
While 15 years of concerted global efforts to reduce maternal mortality have resulted in significant progress, far too many women are still dying and striking inequities persist. According to the report, maternal mortality remains 14 times higher in poor countries than developed regions, a disparity that is partially attributable to unsanitary birth conditions.
The article, written by a team of researchers from organizations including WaterAid, the World Health Organization, the London School of Hygiene and Tropical Medicine, UNICEF and the United Nations Population Fund, estimates that 289,000 would-be mothers died from unsanitary conditions, either at home or in healthcare facilities, in 2013.
Sanitation needs have been ‘woefully neglected’
Lack of water and sanitation is a global public health problem that researchers have described as “woefully neglected.” A 2010 study estimated that nearly 20% of the world’s population still defecates in the open and 2.6 billion people do not have access to even a basic toilet. The consequences are severe, particularly for children: Unsafe sanitation and drinking water, as well as poor hygiene, account for at least 7% of the total global disease burden, and nearly 20% of all child deaths worldwide.
“We have known since Victorian times about the importance of clean water and good hygiene in birth. Yet today tens of thousands of mothers will be giving birth in places where doctors and midwives, if present, do not have access to clean water,” says Dr. Yael Velleman, senior policy analyst, sanitation and health, at WaterAid.
A companion article in PLOS One describes conditions in Tanzania, where less than one-third of births occur in places with safe water and basic sanitation. Nearly 8,000 women in the East African country die each year, either while giving birth or immediately afterwards; 10 percent of those deaths are directly attributable to sepsis, a complication caused by the body’s response to an infection.
Adding sanitation to UN Development Goals
The United Nations’ eight Millennium Development Goals — which include improving maternal health and reducing child mortality — are winding down next year. To follow up on progress toward the MDGs, world leaders are working the the U.N. to come up with Sustainable Development Goals, which are expected to be adopted in September 2015.
Dr. Velleman and her co-authors say providing clean water and sanitation should be at the top of the list of improvements in homes and healthcare facilities in developing countries. She adds that the new goals need to specifically include improved water quality and sanitation as a stand-alone aim with an eye toward improving maternal and newborn health.
“[T]he paper reminds us of something that we’ve known for several hundred years: that you can’t provide good care for mothers and babies if you don’t have basic, clean conditions in which they can give birth,” said Dr. Velleman. “We’ve focused so much on providing emergency obstetric care as a key strategy for addressing maternal mortality, but we’ve forgotten very much about the basics, which is the conditions in which women give birth.”
On December 15, nine leading health organizations spearheaded by the London School of Hygiene and Tropical Medicine issued a call to action for governments around the world to focus on better water quality, sanitation and hygiene. The aim is to make greater progress toward improving maternal and neonatal health.
“The process of giving life,” said Dr. Velleman, “should not mean unduly risking death.”
About the UN Millennium Development Goals:
- In 2000, the United Nations set out eight Millennium Development Goals to achieve by 2015, forming a blueprint for development.
- There is progress on a goal to reduce the maternal mortality rate by three-quarters; last year, 210 mothers died out of every 100,000 live births — a decline of 45% from 1990. But the maternal mortality ratio in developing regions remains 14 times higher than in developed regions.
- Newborn mortality is particularly difficult to address. Fewer children under five are dying, from 12.7 million in 1990 to 6.3 million in 2013. But the proportion of newborn deaths is increasing. In 2013 45% of deaths of under fives occurred in the first month of life, according to the WHO.
- The goal on sanitation is among the most off-track. WaterAid analysis shows Sub-Saharan Africa will not reach its goal, to halve the proportion of people without access to basic sanitation, for 150 years, at present rates of progress.
- The UN is now negotiating a new set of Sustainable Development Goals to pick up from 2015. WaterAid joins partner organizations in calling for a standalone goal on universal access to water and sanitation in homes, healthcare settings and schools; and the inclusion of water, sanitation and hygiene targets into goals for improving maternal and newborn health.