Each year, an estimated 287,000 women worldwide die from pregnancy-related causes, and approximately three million newborns do not survive past the first 28 days of life. The majority of these deaths occur in developing countries at or around the time of delivery, and result from treatable conditions that could be prevented with adequate care. However, more than a third of women in the developing world do not give birth in a health facility that has properly trained staff and adequate equipment. The vast majority of these women with an unmet need for delivery care—36 million out of the 44 million—live in Sub-Saharan Africa and South Asia. These findings come from a new Guttmacher Institute study, Adding it Up: The Need for and Cost of Maternal and Newborn Care—Estimates for 2012, by Susheela Singh, Jacqueline E. Darroch and Lori S. Ashford.
Between 2008 and 2012, the proportion of women in the developing world who delivered in health facilities increased from 55% to 64%. However, the proportion varied widely across subregions. In 2012, rates were lowest in Eastern Africa (44%), Western Africa (47%) and South Asia (51%) and highest in South America (94%), Central Asia (95%) and Eastern Asia (99%). Despite the substantial improvements in recent years, 44 million women in the developing world, as well as their newborns, lacked facility-based delivery care in 2012. The unmet need for delivery care was many times higher in the 69 poorest countries (49%) than in the rest of the developing world (6%).
"Delivering in a health facility with the assistance of trained health professionals and having access to emergency care should complications arise are absolutely critical to saving lives," said Susheela Singh. "But making sure women receive adequate antenatal care is no less important to protecting the health of pregnant women and their newborns, and improvements in this area are happening much too slowly."
Overall, in 2012, only about half (55%) of women who gave birth in the developing world had at least four antenatal visits, the minimum number recommended by the World Health Organization (WHO). Because access to care largely depends on the strength of a country's health system, there is a significant disparity between the proportion of women receiving adequate antenatal care (the WHO-recommended 4+ visits) in the 69 poorest countries (44%) and the proportion receiving such care in developing countries with higher per capita incomes (81%). In Sub-Saharan Africa, progress in providing antenatal care has been minimal; the number of women lacking appropriate care actually increased between 2008 and 2012, because increases in service provision did not keep pace with the rising number of births each year.
The study also found that obtaining antenatal care does not necessarily mean that a woman receives all of the essential services needed to ensure a healthy pregnancy. For example, in the developing world, about one-third of women with some professional antenatal care did not have at least one urine test, and a similar proportion did not have at least one blood test. Periodic urine and blood tests are recommended to screen for hypertensive disease and to assess anemia status and the need for iron supplementation. Among women who gave birth in 2012, 41% of those in Sub-Saharan Africa and 37% of those in the 69 poorest countries did not take any iron supplements.
Providing the current level of pregnancy care to women and newborns costs about US$ 11 billion per year; providing the WHO-recommended level of antenatal, delivery, newborn and postnatal care to all women—both those currently receiving services and those who have an unmet need for care—would require doubling expenditure levels to US$24 billion. Like current spending, the additional US$13 billion in costs could be shared among national governments, donor agencies and households.
"Extensive efforts have been made in recent years to improve reproductive health services and reduce maternal and child mortality, and although we are beginning to see the impact of that investment, the level of unmet need for essential care for mothers and newborns remains very high," said Jacqueline E. Darroch. "The tremendous gains that would result from providing quality pregnancy and delivery services to all women and families would far outweigh the cost of providing these services to all who need them."