Maternal morbidity, disability and their consequences: neglected agenda in maternal health

Photo: Wen-Yen KingThis is a special issue of the Journal of Health, Population, and Nutrition published by the International Centre for Diarrhoeal Disease Research, Bangladesh. This body of work is a substantial contribution to what has been an insufficient amount of evidence on maternal morbidity and disability globally.The issue includes a group of studies from both Bangladesh and India that examine the long-and short-term consequences of maternal complications for mothers and newborns, and documents the physical, social, psychological and economic impacts of maternal ill-health and maternal and perinatal death on women and others living in the family unit.To read the issue, please click here.Key findings:

• A study in Bangladesh found that for every maternal death, there are approximately 40 severe/less-severe complications and over 160 postpartum morbidities/disabilities. This is much higher than previous estimates
• The studies from India and Bangladesh describe a vast range of effects on both mother and child following obstetric complications. For instance, there was an array of quality of life issues e.g. beyond the physical results of fistula, uterine prolapse, and incontinence, there was evidence of effects on women’s daily activities
• A study from Bangladesh highlighted that the subordinate role of women subjects them to hardships and injustices that result from their chronic morbidities and disabilities
• In Bangladesh, it was found that in the instance of a perinatal death, the consequences on the mother may include postpartum depression, emotional violence, and controlling behaviour by the family and the community
• A study in Bangladesh found that maternal morbidity led to a large financial burden up to six weeks after birth, yet that burden declined substantially by six months
• The same study found that faced with maternal complications, families take loans and sell assets to pay for healthcare. It was found that even the poorest households were resilient to the economic shock of paying for obstetric emergencies. Families thus invested in their women

Recommendations:1) Women should be screened several times following the birth, whether inside or outside a healthcare facility, and:

• All women need to be screened for physical postpartum problems, including anaemia, infection, incontinence, uterine prolapse, and obstetric fistula, and be managed, along with the provision of family planning and counselling, for taking care of themselves and their babies
• Women need to be screened for postpartum depression and experience of emotional, physical and sexual violence
• Health professionals need to assess and follow-up especially when the birth has taken place at home, and particularly to follow-up on survivors of a maternal or perinatal death
• There needs to be a call to action to highlight the importance of postpartum and postnatal care that goes beyond the standard four to six week period.

2) There should be improvements in the healthcare system to build individual expertise and organisational capacity to respond to and effectively treat problems ranging from severe uterine prolapse and fistula, requiring specialized surgery, to depression and violence, requiring specialised counselling and intervention3) An effective health system should be put in place to provide accessible preventive and lifesaving care, particularly for the most economically- and socially- vulnerable population4) Issues of status and human rights of women should be highlighted, where the answers will be found in education, employment, and empowerment of women, in partnership with men. This is important because societal customs and expectations set the stage for perpetrating and condoning the emotional, physical and sexual abuse that women experience as a result of chronic morbidities and disabilities.To read the article, click here. No subscription or payment required.Koblinsky, M., Chowdhury, M. E., Moran, A., & Ronsmans, C. (2012). Maternal morbidity and disability and their consequences: neglected agenda in maternal health. Journal of Health, Population, and Nutrition, 30(2), 124–30.